This article sought to describe a new modification of the Melody^® valve that allows percutaneous pulmonary valve implantation (PPVI) in complex outflow tracts.

PPVI has been validated as a valuable therapeutic option for the management of patients with dysfunctional right ventricular outflow tracts (RVOT). However, complex and unfavorable RVOT anatomy continue to limit the indications for PPVI.

Between April 2012 and November 2013, PPVI was performed in 10 patients (mean age=16,3±5years old) using a new modification of the Melody^® valve consisting in a manual shortening of the Melody by folding the 2 extremities of the stent. We reviewed the results of this technique.

Indications were short RVOT in 3 patients, prevention of retrosternal compression in 2 patients, bioprosthetic valves in 4 and coronary arteries proximity in one. No complication occurred during procedures. All patients had excellent hemodynamic results (mean post PPVI RV-PA gradient was 14±6mmHg, 3 patients had trivial pulmonary regurgitation (PR) and the remaining had no PR). After a mean follow-up of 8months (range 2–18months), no patient had reintervention. No valve dysfunction or stent fractures were observed (Fig. 1A and B).

The ‘Folded valve technique’ is a safe modification of the Melody^® valve. By shortening the valve, this technique allowed PPVI in short and complex RVOTs with vulnerable neighbourhood.