Traumatic Compression of a Percutaneous Valve-in-Valve Right Ventricle–to–Pulmonary Artery Conduit in a Young Athlete

BACKGROUND: Exercise is beneficial in adult congenital heart disease, but patients with prosthetic materials, including valve-in-valve right ventricle-to-pulmonary artery (RV-PA) conduits, require tailored advice regarding high-impact sports. CASE SUMMARY: A 19-year-old man with repaired pulmonary atresia, ventricular septal defect, and valve-in-valve RV-PA conduit placement developed exertional dyspnea after blunt chest trauma during competitive ice hockey. Imaging revealed significant prosthetic conduit stenosis due to stent compression. He underwent urgent surgical conduit replacement, with full recovery. DISCUSSION: This case illustrates a rare complication of blunt trauma leading to prosthetic conduit failure. It highlights the need for dynamic imaging and reinforces guideline-based counseling to avoid collision sports in those with valve-in-valve RV-PA conduits. Holistic approaches including shared decision-making regarding exercise prescription and regular reassessment is essential in managing exercise safely in patients with adult congenital heart disease. TAKE-HOME MESSAGE: Trauma threatens anterior prosthetic valves, with timely dedicated imaging and personalized exercise prescription being essential.