Sebastian Góreczny

Valve‐in‐valve (ViV) implantation offers a less invasive treatment for degenerated bioprostheses. However, experience with ViV implantation in large self‐expanding pulmonary valves is limited, and optimal sizing and stability remain uncertain. A young woman with Noonan syndrome and severe lymphatic disorder underwent implantation of a 36–25 mm VenusP‐valve (Venus Medtech) for severe pulmonary regurgitation. Six years later, the valve showed a mild gradient increase and moderate regurgitation (cardiac magnetic resonance regurgitation fraction of 30%). Given her severe lymphatic disorder, repeat percutaneous valve implantation was performed. A second 36–25 mm VenusP‐valve was implanted within the existing valve. Incomplete frame apposition was improved with balloon dilation. At 2‐year follow‐up, there was no systolic gradient and only trace pulmonary regurgitation. Multiple ViV configurations were evaluated in a pulsatile flow system, including one‐size‐smaller VenusP‐valves, a balloon expandable valve, and modified self‐expanding valves with flares removed. Effective orifice area (EOA) and regurgitation fraction (RF), including central and paravalvular leakage, were assessed. All configurations showed complete inner‐frame expansion and unrestricted leaflet motion, with EOA exceeding predefined acceptance thresholds and RF remaining in the single‐digit range. No migration occurred with inner valves one to two sizes smaller than the outer valve under standard conditions, whereas substantially undersized configurations demonstrated instability at higher pressures. ViV implantation within a large self‐expanding VenusP‐valve was feasible, with favorable function at 2 years. Bench testing demonstrated favorable hydrodynamic performance and supported the stability of appropriately sized inner valves. Further preclinical and clinical evaluation is warranted.

Introduction Developments in fusion imaging (FI) software have facilitated easy use of three-dimensional (3D) roadmaps based on preregistered computed tomography (CT) or magnetic resonance imaging (MRI) datasets for guidance of cardiac catheterizations. Aim The aim of this study was to...

Recent introduction into clinical practice of large self-expanding valves addressees the issue of dilated dysfunctional right ventricular outflow tracts (RVOTs). The purpose of this study was to determine the safety and short-term efficacy of the VenusP-valve (Venus MedTech) implantation in the pulmonary position in the pediatric group of patients with emphasis on the evolving qualification criteria and implantation techniques. Over a 14-month period, 15 patients < 18 years-old with severe pulmonary regurgitation underwent successful PPVI with the self-expanding VenusP-valve. All types of RVOT anatomies were represented in the study group. Desired valve position during the first attempt was achieved in 13 patients (87%). When compared between the first and second half of the study period, there was a significant difference toward less oversizing: 3.3 ± 1.4 mm versus 1.8 ± 0.7 mm, p = 0.039. On final angiography, trivial pulmonary regurgitation was present in 9 patients (60%). In the remaining 6 patients (40%), the valve was competent. Adverse events were limited to two patients (13.3%) with transient rhythm disturbances without any clinical sequelae. During a median follow-up of 11.5 months (range 7.9–21 months), all the valves remained normally functioning with no need for reinterventions and no episodes of infective endocarditis. The VenusP-valve implantation was safely and effectively performed in pediatric patients with all types of large dysfunctional RVOTs. With modified techniques of implantation, limited femoral vein access or stented pulmonary artery branches, the valves can be successfully implanted.

Fontan conduit stenosis can impair haemodynamics, necessitating stent implantation. We present a 16-year-old patient who developed platypnea-orthodeoxia syndrome due to a post-stenting baffle leak. Despite initial diagnostic challenges, a second catheterisation confirmed and successfully sealed the defect with a covered stent. This case highlights the need for close monitoring and prompt intervention to manage complications in Fontan patients.

Staged Fontan pathway treatment is a recognised surgical approach for managing congenital heart lesions with single ventricle physiology. Some patients necessitate communication between the tunnel and the atrium to maintain circulatory balance. During follow-up, adjustments to fenestration size may be required. While methods for enlarging or completely closing fenestrations are common, partially reducing flow through a fenestration remains challenging. We present an effective technique for partially reducing the size of a large, stented fenestration using a coronary stent and a vascular occluder.

Ductus arteriosus (DA) stenting is a well-established interventional alternative to surgical systemic-to-pulmonary shunts in neonates with congenital heart defects and ductal-dependent pulmonary circulation (DDPC). While it avoids sternotomy and cardiopulmonary bypass, the procedure remains technically demanding, especially in cases involving tortuous or misaligned ductal anatomy. Such anatomical complexity is associated with increased procedural difficulty and a higher rate of reinterventions. Although echocardiography, computed tomography (CT), and angiography remain key imaging modalities, they may be limited in providing comprehensive spatial context. Virtual reality (VR) has recently emerged as a promising tool that enables interactive 3D visualisation of cardiovascular structures and may enhance preprocedural assessment. This study aimed to evaluate the feasibility and potential benefits of CT-derived VR-based 3D modelling for preprocedural planning in neonates undergoing DA stenting for DDPC. The study compared VR-derived anatomical and procedural assessments with conventional angiographic imaging. Between March 2021 and August 2023, six neonates with DDPC underwent preprocedural contrast-enhanced CT and were included in this single-centre retrospective study. Three additional patients referred for DA stenting without CT were excluded. Dedicated VR software (VMersive, Poland) was used to automatically generate interactive 3D models from CT datasets without manual segmentation. The models were evaluated using immersive VR headsets and controller-based tools for precise anatomical assessment. DA morphology, tortuosity classification, total ductal length [L1], straight-line distance [L2], curvature index (CI), optimal fluoroscopic projection, and vascular access were analysed in VR and compared with angiographic data. Paired t-tests were used for statistical comparison, with significance set at p < 0.05. All six VR models were successfully created in under 5 min. Morphological and tortuosity classification: VR-based assessments were consistent with angiographic classification (Type I–III), confirming reliability. Length and curvature: VR-derived [L1] values were significantly longer than angiographic measurements (mean: 28.93 mm vs. 24.14 mm; p = 0.038). Curvature index was significantly higher in VR (mean: 0.46 vs. 0.29; p < 0.001), especially in Type III ducts, suggesting that angiography underestimates vascular tortuosity. Projection planning: Median angular deviation between VR-recommended and final procedural projections was 12° (range: 6–30°, p = 0.259). In cases requiring multiple contrast injections, final projections closely matched VR suggestions, indicating VR’s potential to reduce radiation exposure and procedural time. Vascular access: VR-predicted access matched initial operator choice in 3/6 cases (50%), rising to 5/6 (83%) when reinterventions were included. Adjacent structures: VR allowed simultaneous visualisation of DA and adjacent thoracic structures. In patients with anomalous pulmonary venous return, VR clarified spatial relationships and potential compression risk. Additionally, in one case, a persistent vertical vein was identified, guiding a rare, combined intervention strategy. VR-based 3D modelling from CT data are a feasible and effective tool for preprocedural planning in DA stenting. It provides accurate spatial insight into ductal anatomy, curvature, projection alignment, and access routes. VR enhances anatomical understanding, supports multidisciplinary planning, and may reduce procedural uncertainty, particularly in complex neonatal interventions.

CHDs affecting the right ventricular outflow tract often require repeated surgical or transcatheter interventions due to pulmonary insufficiency or stenosis. This study presents percutaneous implantation of large self-expanding valves in patients with complex right ventricular outflow tract anatomy after prior pulmonary branch stenting.