Surgical retrieval and repositioning of malpositioned prosthetic pulmonic valve in a patient with situs inversus dextrocardia and tetralogy of Fallot: a case report

Introduction: Percutaneous pulmonary valve implantation (PPVI) offers a minimally invasive alternative to surgical valve replacement in patients with right ventricular outflow tract dysfunction. However, valve malposition or migration can occur, necessitating surgical retrieval. Case presentation: We report a 16-year-old male with situs inversus dextroposition, mirror-image dextrocardia, and repaired Tetralogy of Fallot (TOF), who developed severe pulmonary regurgitation and underwent PPVI using a MyVal valve in another hospital. Post-procedural imaging revealed valve malposition at the right pulmonary artery bifurcation with paravalvular leakage. Surgical retrieval and reimplantation of the same prosthetic valve were successfully performed on a beating heart under cardiopulmonary bypass. Discussion: This case highlights the challenges of percutaneous interventions in complex congenital heart anatomies and the role of early surgical management in salvaging malpositioned valves. Beating-heart reimplantation minimized myocardial ischemia and facilitated rapid recovery. Conclusion: Prompt surgical retrieval and reimplantation of malpositioned PPVs can preserve valve function, reduce morbidity, and optimize outcomes in complex congenital heart disease.