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The patient is a 22-year-old female with a history of pulmonary atresia and ventricular septal defect. She was operated three times and during the last intervention the right ventricle-pulmonary artery conduit was changed because stenotic and was inserted a Shellhigh 23 mm. She developed significant pulmonary valve regurgitation and some degree of stenosis. The patient was scheduled for percutaneous pulmonary valve implantation that was done in two stages because of complex anatomy and long-time procedure. During the first procedure, two stents were implanted in the LPA and in the RV-PA conduit; the final results was a perfect landing zone for the following percutaneous valve and a severe pulmonary regurgitation (Panel A white arrows). In order to have as many information as we can, before and during the 2nd procedure a multi-modal imaging evaluation was done. She firstly underwent a CT scan (Panels B and C), and the information were used to create a 3D-printed model (Materialise's Heartprint, 3D-printed model-NV, Leuven, Belgium); this model allowed us both to better understand the anatomy and the complex relationship with the coronary arterial course (Panels D–F), and try to implant a valve before the procedure (Panels G and H). During the 2nd procedure, a 3D Rotational angio was obtained and 3D images were reconstructed in the interventional suite (using a 3DRA XtraVision workstation from Philips Healthcare, Best, The Netherlands). These images allows accuracy in evaluation of relationship between the right outflow anatomy and the coronary arterial course (Panels I and J). A 23 mm Sapien Valve (Edward Lifesciences, Irvine, CA, USA) was implanted without complications and with a successful final result, without valve regurgitation (Panel K).

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Cardiovascular Flashlights
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