Percutaneous pulmonary valve implantation (PPVI) with self-expanding valves, such as the VENUS P, has expanded treatment options for patients with large RVOT anatomies. However, concerns persist regarding valve durability and subclinical leaflet abnormalities, including hypoattenuated leaflet thickening (HALT) and reduced leaflet motion (HAM) ( Fig. 1 ). The incidence and clinical impact of these findings after PPVI remain poorly defined.

Baseline, post-procedural and 6 months follow-up data were prospectively analyzed for 51 patients who underwent PPVI with Venus-P (Jan 2022–Dec 2025). At 6-month follow-up, all patients underwent cardiac CT to assess the presence of leaflet abnormalities (HALT and HAM).

Of the 51 patients 49% were male with a mean age of 40.1 ± 14.5 years. Thirty-seven patients had Tetralogy of Fallot. The main indication for percutaneous pulmonary valve implantation was pulmonary regurgitation (98%) associated with right heart chamber dilation.

The median valve diameter was 34 mm (IQR: 32–36); At 6-month follow-up, HALT was detected in 25 patients (49%), whereas HAM was observed in 7 patients (13.7%). HAM was associated with impaired leaflet motion without any significant increase in transvalvular gradients on echocardiography. RVOT Vmax values were comparable between the two groups (no HALT versus HALT/HAM) at all time points(after PPVI T1: 1.64 vs 1.55, P = 0.459; at 6 months T2: 1.69 vs 1.76, P = 0.467).

In this cohort of patients undergoing PPVI with VENUS P valves HALT was a frequent finding at 6-month follow-up, whereas HAM was less common and not associated with hemodynamic valve deterioration on echocardiography. And there were no statistically significant differences between the two groups. These findings suggest that, although subclinical leaflet abnormalities are common after PPVI, their short-term clinical impact appears limited.