In running a structural heart program, we are frequently asked to take on exceptional clinical challenges, often for which there has been no (or very little) precedent.

Recently, we were asked to consider a performing percutaneous valve implant in a critically narrowed previously implanted surgical valve in a 30 year-old man. This man was born with congenital heart disease where his heart comprised a single ventricle (i.e. one pumping chamber rather than the normal two).

This man was very frail and could not undergo open heart surgery, particularly since he had already had two previous open heart operations.

The narrowed heart valve was in the pulmonary position (though it functioned as his aortic valve as he had a single ventricle).

Using our heart team approach, we were able to perform a world-first percutaneous valve-in-valve implant in a man with a single ventricle.

There were many innovations that the team had to introduce to make this case successful.

For example, ALL the patient’s arteries were technically too small to introduce the keyhole heart valve. To solve this problem we used a special expandable sheath (tube) that could be introduced into this man’s femoral artery in a very small size and then his artery was gently expanded to the requisite size from within with a balloon.

We also used a different transcatheter valve (a CoreValve), one where the valve is located above the patient’s previous valve so that we wouldn’t obstruct the old valve.

Our article on this case has recently been accepted for publication in the prestigious Journal of American College of Cardiology: Cardiovascular Interventions.

This case, one of many, highlights the extraordinary capacity of our heart team to deal with exceptional and unique problems and solve them, if need be, by unique tailored solutions.