<p>Percutaneous pulmonary valve implantation : our first cases</p>

<p>Introduction: Once adults, 80% of patients who underwent surgical palliation of cono-troncale congenital heart disease will require reintervention on the right ventricle outflow tract (RVOT). The structural valve deterioration of almost all bioprosthetic valve and the necessity of recurrent reintervention obliged us to avoid the open repair and put the percutaneous pulmonary valve implantation (PPVI) in the first line. We report the two first cases of PPVI in Tunisia.</p>

<p>Case1:&nbsp; A 16-year-old boy who was initially diagnosed with pulmonary atresia surgically repaired twice during his life course. He was referred to our department for a degeneration of his pulmonary homograft in a stenotic way. We performed a PPVI and decreased the right ventricle systolic pressure (RVSP) from 80 to 30 mmHg. The patient remains asymptomatic till this day.</p>

<p>Case 2:&nbsp; A 14-year-old boy, who had previously an anatomical repair of a transposition of the great arteries, was transferred to our cathlab for a pulmonary valve stenosis. The RVSP was 130 mmHg and he was complaining from dyspnea (NYHA II). We proceeded to a percutaneous implantation of a Melody valve and decreased the gradient to 40 mmHg.</p>

<p>There was no any immediate post-procedure incident and the convalescence period was uneventful for both patients.</p>

<p>Discussion: This is a very limited report but with similar short and medium term results to the recent data. RVOT surgical repair is the most realized procedure for grown up congenital heart disease. We expect the transcatheter valve technology to evolve and progress as so.</p>

<p>Conclusion: 7 years after the first surgical pulmonary valve replacement in Tunisia, the percutaneous option is on the way of being the gold standard modality of repair for these patients. The main challenge we are actually facing is that less than 20% from all patients subject to PPVI may benefit from it due to thelarge variety of shape of the RVOT and the paucity of large prosthesis available for native RVOT.</p>