Transcatheter Repair of a Sinus Venosus Defect With a Modified Harmony Transcatheter Pulmonary Valve Prosthesis

Transcatheter repair of sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return (PAPVR) has become an acceptable surgical alternative for appropriately selected patients. Dilated cardiac anatomy may limit candidacy because of size limitations in balloon-expandable covered stents (BECSs). An 83-year-old man with SVASD with PAPVR presented with decompensated right heart failure secondary to a long-standing left-to-right shunt. Cardiac dimensions precluded the use of a BECS, and we modified a Harmony transcatheter pulmonary valve 22 mm (HTPV22, Medtronic) by removing the leaflets to use the self-expanding frame to cover the SVASD. Following release, the HTPV22 frame was anchored with additional BECSs to secure the frame within the superior vena cava. At 1-month follow-up, there was complete sealing of the SVASD and unobstructed pulmonary venous return to the left atrium. This report describes an innovative modification of the HTPV22 to allow for successful transcatheter repair of a large SVASD.