Abstract
OBJECTIVE: To describe the use of a balloon-assisted technique for placement of a Harmony valve in a patient with tetralogy of Fallot and a dilated right ventricular outflow tract (RVOT). KEY STEPS: Harmony valve malalignment can happen with pyramidal-type outflow tracts. Using a large compliant balloon, we inflated the balloon across the misaligned segment of the partially deployed Harmony valve. Once correctly aligned in the RVOT, we proceeded with standard deployment. POTENTIAL PITFALLS: Retrieval of the valve back into the delivery catheter can be difficult to impossible and may require use of a Gore 26-F DrySeal sheath to retrieve. TAKE-HOME MESSAGES: Complex and dilated RVOTs make deployment of self-expanding valves difficult, with a higher probability of malalignment. We describe a simple "buddy balloon" technique for reorienting the distal valve apparatus to reposition the valve optimally in the RVOT before release.