For many patients with right ventricular outflow tract (RVOT) dysfunction, percutaneous pulmonary valve implantation (PPVI) offers a less-invasive alternative treatment option to surgery with a similar long-term result. However, the implantation of the valves recently available on the European market was only possible in patients with a limited maximal RVOT diameter. In patients with large RVOT, surgical treatment has remained the only possible treatment modality until recently. The self-expandable Harmony transcatheter pulmonary valve is a valve dedicated for patients with severe pulmonary regurgitation in the native and surgically repaired wide RVOT. The initial experience worldwide with this valve is very promising. However, it has not been implanted in Europe until recently. We report on four young adult patients with severe pulmonary valve regurgitation who underwent a successful PPVI with Harmony valve implantation. There were no serious complications in our small study group. In conclusion, the Harmony valve may offer a less-invasive and safe treatment alternative to surgery for patients in whom the available balloon-expandable valves offer only limited applicability. This valve has only recently become accessible on the European market.

Vascular access-related complications are an important consideration in patients undergoing cardiac catheterisation. Patients with CHD are increasingly undergoing percutaneous treatment for suitable procedures as an alternative, less invasive option to surgical intervention. As such, recognition and treatment of these complications are becoming increasingly important. We present a case of a patient with repaired Tetralogy of Fallot who developed a femoral arteriovenous fistula and femoral artery pseudoaneurysm arising from an accessory arterial branch following percutaneous Harmony valve implantation, both of which were treated endovascularly with placement of a stent.