Successful transcatheter pulmonary valve implantation under elective extracorporeal membrane oxygenation in a patient with tetralogy of Fallot with biventricular failure and ventricular tachycardia: a case report

Background: We report a case of successful transcatheter pulmonary valve implantation (TPVI) with elective extracorporeal membrane oxygenation (ECMO) support in a high-risk patient with complex congenital heart disease complicated by severe biventricular heart failure and ventricular tachycardia (VT). Case summary: A 55-year-old woman with a history of tetralogy of Fallot underwent surgical repair at the age of 3 years. At 50 years of age, the patient underwent bioprosthetic pulmonary valve replacement because of severe pulmonary regurgitation. Two years later, valve thrombosis required valve replacement, followed by infective endocarditis, leading to progressive pulmonary valve stenosis and regurgitation. This results in right ventricular dilation, biventricular failure, and recurrent VT. Given its high surgical risk, TPVI was selected. Owing to the impaired cardiac function and arrhythmia risk, elective ECMO support was planned to prevent intraoperative haemodynamic collapse. On the day of the procedure, ECMO was initiated in the hybrid OR, and TPVI was successfully performed using a 26 mm SAPIEN 3 valve. ECMO provided stable haemodynamics throughout the procedure, and the patient was successfully weaned postoperatively in the hybrid room. The patient had no complications and was discharged on postoperative Day 6. Discussion: Reports on TPVI with elective ECMO support are limited. This case suggests that in high-risk patients with severe heart failure and arrhythmias due to pulmonary valve dysfunction, elective ECMO can provide haemodynamic stability and allow TPVI to be safely performed with favourable outcomes.