Percutaneous self-expanding pulmonary valve implantation in a patient with extremely close coronary arteries

A 39-year-old male with previous surgical correction of a primum atrial septal defect and patch augmentation of pulmonary artery stenosis presented with severe pulmonary regurgitation.Transthoracic echocardiography showed a dilated right atrium, moderate to severe tricuspid regurgitation, and significant right ventricular (RV) dilation with preserved systolic function.Cardiopulmonary exercise testing showed a decline in VO2 max from 30.6 ml/kg/min (78% predicted) to 24.9 ml/kg/min (61% predicted).Cardiac magnetic resonance imaging confirmed severe RV dilation (end-diastolic volume 216 ml/m 2 ) with preserved ejection fraction (52%) and free pulmonary regurgitation fraction (51%).