{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:55:54Z","timestamp":1790582154896,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Valve\u2010in\u2010valve (ViV) implantation offers a less invasive treatment for degenerated bioprostheses. However, experience with ViV implantation in large self\u2010expanding pulmonary valves is limited, and optimal sizing and stability remain uncertain. A young woman with Noonan syndrome and severe lymphatic disorder underwent implantation of a 36\u201325 mm VenusP\u2010valve (Venus Medtech) for severe pulmonary regurgitation. Six years later, the valve showed a mild gradient increase and moderate regurgitation (cardiac magnetic resonance regurgitation fraction of 30%). Given her severe lymphatic disorder, repeat percutaneous valve implantation was performed. A second 36\u201325 mm VenusP\u2010valve was implanted within the existing valve. Incomplete frame apposition was improved with balloon dilation. At 2\u2010year follow\u2010up, there was no systolic gradient and only trace pulmonary regurgitation. Multiple ViV configurations were evaluated in a pulsatile flow system, including one\u2010size\u2010smaller VenusP\u2010valves, a balloon expandable valve, and modified self\u2010expanding valves with flares removed. Effective orifice area (EOA) and regurgitation fraction (RF), including central and paravalvular leakage, were assessed. All configurations showed complete inner\u2010frame expansion and unrestricted leaflet motion, with EOA exceeding predefined acceptance thresholds and RF remaining in the single\u2010digit range. No migration occurred with inner valves one to two sizes smaller than the outer valve under standard conditions, whereas substantially undersized configurations demonstrated instability at higher pressures. ViV implantation within a large self\u2010expanding VenusP\u2010valve was feasible, with favorable function at 2 years. Bench testing demonstrated favorable hydrodynamic performance and supported the stability of appropriately sized inner valves. Further preclinical and clinical evaluation is warranted.<\/jats:p>","DOI":"10.1002\/ccd.70872","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:10:36Z","timestamp":1790579436000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Example and Bench Testing of Hydrodynamic Performance and Migration Stability of Various Valve\u2010in\u2010Valve Configurations within a Large\u2010Housing Self\u2010Expanding Pulmonary Valve"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6825-6745","authenticated-orcid":false,"given":"Sebastian","family":"G\u00f3reczny","sequence":"first","affiliation":[{"name":"Department of Cardiac and Vascular Diseases St. John Paul II Hospital Krakow Poland"},{"name":"Department of Cardiology, Institute of Heart Diseases University Clinic Hospital Wroclaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4279-6102","authenticated-orcid":false,"given":"Damien","family":"Kenny","sequence":"additional","affiliation":[{"name":"The Department of Paediatric Cardiology and Cardiothoracic Surgery Children's Health Ireland Crumlin Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_7_2_1","article-title":"Current Status of Transcatheter Intervention for Complex Right Ventricular Outflow Tract Abnormalities","volume":"2024","author":"Kagiyama Y.","year":"2024","journal-title":"Global Cardiology Science and Practice"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25544"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30968"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.07.036"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.125.015196"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.70457"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246\u2010025\u201004048\u20104"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jead260"},{"key":"e_1_2_7_10_1","article-title":"Outcomes of Hypoattenuating Leaflet Thickening Post\u2010Transcatheter Pulmonary Valve Replacement","volume":"4","author":"Sefton C.","year":"2025","journal-title":"Journal of the American College of Cardiology: Advances"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.05.021"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30901"},{"key":"e_1_2_7_13_1","article-title":"Innovative Stent Reshaping With Dual Balloon Ovalization and Circular Reformation for Optimized Valve\u2010in\u2010Valve Implantation","volume":"30","author":"Allam H.","year":"2025","journal-title":"Journal of the American College of Cardiology: Case Reports"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.939297"},{"key":"e_1_2_7_15_1","first-page":"468","article-title":"Transcatheter Pulmonary Valve\u2010in\u2010Valve Implantation","volume":"15","author":"Matoq A.","year":"2023","journal-title":"Interventional Cardiology"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28819"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.25270\/jic\/25.00029"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70872","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70872","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70872","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:10:38Z","timestamp":1790579438000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":16,"alternative-id":["10.1002\/ccd.70872"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70872","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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