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This case describes a 31-year-old with hypoplastic left heart syndrome who developed severe neoaortic valve stenosis and moderate regurgitation. Percutaneous Melody valve placement in the neoaortic position successfully treated the obstruction, improving hemodynamics and initially improving heart failure symptoms. ",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/case-report-of-melody-valve-placement-to-treat-neoaortic-valve-stenosis-in-an-adult-with-fontan-circulation/437282/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/case-report-of-melody-valve-placement-to-treat-neoaortic-valve-stenosis-in-an-adult-with-fontan-circulation/437282.png","ImageObject",300,407,{"name":92,"@type":93},"Stanford","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What condition was treated in this case report?","Question",{"text":113,"@type":114},"Severe neoaortic valve stenosis with moderate regurgitation in an adult with hypoplastic left heart syndrome and Fontan circulation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How was the Melody valve placement performed?",{"text":118,"@type":114},"The Melody valve was delivered retrograde across the neoaortic valve using a Safari wire, with a Palmaz 3110 bare metal stent crimped on the outside of the valve, and expansion improved the valve gradient.",{"name":120,"@type":111,"acceptedAnswer":121},"What was the patient’s outcome after the intervention?",{"text":122,"@type":114},"Heart failure symptoms improved for 6 months, but at 1 year there was moderate regurgitation and exertional symptoms; later, the patient died of septic shock associated with bacterial colitis.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},437282,1790718947,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Journal of the Society for Cardiovascular Angiography & Interventions 4 (2025) 104018  \nJSCAI Case Report  \nCase Report of Melody Valve Placement to Treat Neoaortic Valve Stenosis in an Adult With Fontan Circulation  \nMatthew C. Schwartz, MD a, b, *, Jorge Alegria, MD b, c, Jonathan Schwartz, MD c, Joseph Paolillo, MD a, b  \na Division of Pediatric Cardiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina; b Adult Congenital Heart Disease, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina; c Division of Adult Cardiology, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina  \n| A B S T R A C T |\n| --- |\n| The Melody valve (Medtronic) is commonly used for pulmonary valve replacement in patients with dysfunctional right ventricle to pulmonary artery conduits or bioprosthetic pulmonary valves. Rare reports exist of its use in the aortic position, including only 1 prior description of its use in a patient with hypoplastic left heart syndrome. We describe a 31-year-old patient with hypoplastic left heart syndrome who had severe neoaortic valve stenosis and moderate regurgitation that was successfully treated with percutaneous Melody valve placement in the neoaortic position. |\n\nIntroduction  \nOne prior report describes the use of a transcatheter valve in a patient with hypoplastic left heart syndrome (HLHS) in the neoaortic position.1 We describe transcatheter placement of a Melody valve (Medtronic) in the neoaortic position in an adult male with HLHS to treat neoaortic valve stenosis and regurgitation.  \nCase  \nThe patient was born with critical aortic valve stenosis and underwent surgical valvotomy. The left ventricle was subsequently felt to be too small, and the patient underwent creation of Damus–Kaye–Stansil (DKS) anastomosis. At 9 months, the patient underwent right bidirectional Glenn operation and, at 3 years, underwent Fontan operation. He eventually developed severe neoaortic valve regurgitation and, at 23 years, underwent a complex operation that included takedown of the DKS anastomosis, replacement of the neoaortic root with a 20-mm Hemashield graft (Getinge), thinning of the neoaortic valve leaflets, and recreation of the DKS connection.  \nAt 31 years, the patient developed heart failure. Echocardiogram showed severe neoaortic valve stenosis with a peak instantaneous gradient of 84 mm Hg and mean of 63 mm Hg, as well as moderate regurgitation. The right ventricular (RV) systolic function was severely  \nreduced. Cardiac computed tomography showed thickened neoaortic valve leaflets with limited systolic opening. The neoaortic graft measured 18 mm in the narrowest dimension (Figure 1) . The patient was a poor surgical candidate. Transcatheter intervention was pursued as a bridge to possible eventual transplantation.  \nTable 1 summarizes the hemodynamics at catheterization. Angiography showed that the neoaortic conduit narrowed to 15 mm. The valve leaflets were thick and were immediately proximal to the conduit (Figure 2; Supplemental Videos 1 and 2) . The distance from the neoaortic valve annulus to the DKS connection was 25 mm. From the right femoral artery, the neoaortic valve was crossed retrograde and wire position established with a 0.035-inch Safari wire (Boston Scientific) . The Melody valve was crimped onto a 22-mm Melody Ensemble delivery system. A Palmaz 3110 bare metal stent (Johnson & Johnson) was crimped on the outside of the valve. The ensemble was advanced retrograde over the Safari wire across the neoaortic valve. A pigtail catheter was advanced via the left femoral artery into the ascending aorta for angiography (Figure 3; Supplemental Video 3) . RV pacing was performed via the Safari guide wire during valve expansion (Supplemental Video 4) . After expansion, the gradient across the valve was improved, and there was no regurgitation (Table 1; Figures 4 and 5; Supplemental Videos 5 and 6) .  \nTable 2 describes the subsequent course","cbCaisgbfKaIQCsZ","https://ap.wps.com/l/cbCaisgbfKaIQCsZ","pdf",7591304,"English","# Abstract\n# Introduction\n# Case\n## Hemodynamics and Intervention\n## Follow-up Course\n# Discussion","[{\"question\":\"What condition was treated in this case report?\",\"answer\":\"Severe neoaortic valve stenosis with moderate regurgitation in an adult with hypoplastic left heart syndrome and Fontan circulation.\"},{\"question\":\"How was the Melody valve placement performed?\",\"answer\":\"The Melody valve was delivered retrograde across the neoaortic valve using a Safari wire, with a Palmaz 3110 bare metal stent crimped on the outside of the valve, and expansion improved the valve gradient.\"},{\"question\":\"What was the patient’s outcome after the intervention?\",\"answer\":\"Heart failure symptoms improved for 6 months, but at 1 year there was moderate regurgitation and exertional symptoms; later, the patient died of septic shock associated with bacterial colitis.\"}]","Case Report of Melody Valve Placement to Treat Neoaortic Valve Stenosis in an Adult With Fontan Circulation | PDF",1790680896,13]