Venus P Valve: New Hope For Patients With Congenital Heart Disease

By Asst Prof Foo Jie Sheng, Senior Consultant, Cardiology

Imagine living with a heart condition from birth, undergoing major surgery as a child, and then facing the prospect of another open-heart operation in adulthood. For many adults with repaired Tetralogy of Fallot (TOF), a common congenital heart defect, this has been their reality. But a new treatment option called the Venus P valve is changing that narrative by offering a less invasive way to restore heart function and improve quality of life. Recently introduced at the National Heart Centre Singapore (NHCS), the innovative valve provides hope to patients who previously had limited choices.

Understanding Tetralogy of Fallot (TOF)

To appreciate the significance of Venus P valve, it is helpful to first understand TOF. It is a birth defect that affects about 1 in every 2,500 babies. It involves four structural problems in the heart: a hole between the lower chambers (ventricular septal defect), narrowing of the pathway from the heart to the lungs (pulmonary stenosis), the main artery (aorta) positioned over this hole, and thickening of the right lower chamber's muscle (right ventricular hypertrophy). These issues disrupt normal blood flow, causing oxygen-poor blood to circulate through the body, often leading to a bluish tint in the skin known as cyanosis.

Babies with TOF typically require surgery early in life to close the hole and widen the narrowed pathway. While these repairs save lives and allow most children to grow into adulthood, they are not always perfect. Over time, many patients develop pulmonary regurgitation— a leakage in the valve between the heart and lungs. This backflow forces the right side of the heart to work harder, leading to enlargement, fatigue, shortness of breath, and even heart failure if left untreated. In Singapore, NHCS cares for over 500 adults with repaired TOF, many of whom face these long-term complications. 

What Does Venus P Valve Treat

The Venus P valve primarily addresses severe pulmonary regurgitation in patients with enlarged or irregularly shaped right ventricular outflow tracts (RVOT) — the pathway from the heart to the lungs. This is common after TOF repair, where the original surgery might have involved patching or widening the area, making it too large for standard replacement valves. Without intervention, the leaking valve can strain the heart, reducing exercise tolerance and quality of life. The Venus P valve steps in as a targeted fix, restoring one-way blood flow to the lungs and easing the burden on the heart.

How Does Venus P Valve Work

The Venus P valve is a self-expanding valve made from a flexible nitinol (nickel-titanium) frame covered with a trileaflet porcine pericardial tissue, essentially a pig-derived valve that mimics the natural one. Unlike traditional surgery, which requires cracking open the chest, the Venus P valve is delivered through a minimally invasive procedure called transcatheter pulmonary valve replacement.

Here is how it typically unfolds: Under general anaesthesia, a cardiologist makes a small incision in the groin and threads a catheter (a thin tube) through a vein up to the heart. Using X-ray guidance, the compressed valve is positioned in the faulty RVOT.

Once in place, it expands on its own, anchoring securely and immediately starting to function. The whole process usually takes a few hours, and patients often spend two nights in the hospital before discharge.

This design is particularly clever for large or flared RVOTs, as the valve's flared ends help it fit snugly without needing a balloon to inflate it, unlike some other transcatheter options.

Self-expanding Venus P valve showing (A) frontal view and (B) side view.

Who Is Suitable for Venus P Valve

Not every patient with pulmonary issues qualifies, but the Venus P valve significantly broadens the pool of patients who can receive the minimally invasive treatment. It is ideal for adults who have repaired congenital heart defects like TOF and are experiencing severe valve leakage, an enlarged right ventricle, and symptoms like fatigue or reduced exercise capacity. At NHCS, it is estimated that only about 30% of such patients could previously use existing transcatheter valves as many had heart chambers that became too large or irregularly shaped. The Venus P valve can now be offered to many of the remaining 70% who would otherwise need open-heart surgery. Candidates undergo thorough assessments, including echocardiograms, computed tomography (CT) scans and cardiac magnetic resonance imaging (MRI) , to ensure the anatomy fits the valve's specifications (typically for RVOT diameters of 28-36 mm) and to check that they do not have active infections, severe kidney issues, allergies to the materials, or certain heart rhythms that could complicate the procedure.

How Does Venus P Valve Compare to Traditional Treatments

Traditional approaches for pulmonary valve replacement involve open-heart surgery, where surgeons replace the leaky valve with a biological one. This requires stopping the heart, using a bypass machine, and a lengthy recovery of about or more than 5 days to more than a week in hospital and months off work or activities. Risks include infection, bleeding, and longer-term issues like valve degeneration. In contrast, the Venus P valve is a game-changer with its dramatically shorter recovery.

How Effective Is It

In international studies, procedural success rates hover around 98-100%^1-2, with patients showing significant improvements in heart function metrics like right ventricle size/function and New York Heart Association class² — a measure of symptom severity. Mid-term followup (up to five years) indicates stable valve performance, with lowrates of reintervention^3.

All Venus P valve patients return for regular check-ups with echocardiograms every 12 months to monitor the valve and heart function. The results have been encouraging with most patients reporting better exercise tolerance, and good recovery of right ventricular enlargement and function.

Are There Any Risks

Like any medical procedure, the Venus P valve is not risk-free. Potential complications include valve migration and bleeding around the pulmonary artery1,2 which is rare, about 1-5% as reported in studies, as well as infections like endocarditis, arrhythmias, or stent fractures. Many stent fractures do not affect valve function and do not require treatment. Other risks involve vascular injury at the insertion site, bleeding, or allergic reactions.

Patients should discuss these with their doctor, weighing benefits against risks.

What is Recovery from Venus P Valve Typically Like

Most patients are up and walking the next day, discharged within two to three days, and back to normal activities within a week. This is a dramatic difference from the months of recovery required after open-heart surgery.

At NHCS, six patients have received the Venus P valve since its introduction, including 24-year-old Catherine, who has Down syndrome and repaired TOF. She underwent the procedure for severe pulmonary valve leakage with right heart failure, and was able to regain her energy and resume her daily routine quickly. Like all Venus P valve patients, Catherine has to take blood thinners post-procedure and avoid heavy lifting for a short time, but overall, there is minimal disruption to daily activities.

In conclusion, Venus P valve represents an exciting advancement in congenital heart care, particularly for TOF survivors. By offering a safer, quicker alternative to open-heart surgery, more patients are now able to live fuller lives.

REFERENCES

1. "Transcatheter Pulmonary Valve Implantation Using Self-Expandable Percutaneous Pulmonary Valve System: 3-Year CE Study Results." JACC: Cardiovascular Interventions. 100% success in 50 patients with stable outcomes. URL: https://www.jacc.org/doi/abs/10.1016/j.jcin.2024.12.031](https://www.jacc.org/doi/abs/10.1016/j.jcin.2024.12.031
2. Morgan et al. (2019). "Medium-term results of percutaneous pulmonary valve implantation using the Venus P-valve: international experience." EuroIntervention. High success (100% in 81 patients) and low complications over 25 months. URL: https://eurointervention.pcronline.com/article/medium-term-results-of-percutaneous-pulmonary-valve-implantation-using-the-venus-p-valve-international-experience](https://eurointervention.pcronline.com/article/medium-term-results-of-percutaneous-pulmonary-valve-implantation-using-the-venus-p-valve-international-experience
3. Rashed et al. (2026). "VenusP-Valve: Outcomes Beyond 5 Years." *Catheterization and Cardiovascular Interventions*. This retrospective review evaluates medium- to long-term results, showing high survival (96% at 5 years) and low reintervention rates. URL: https://onlinelibrary.wiley.com/doi/10.1002/ccd.70457](https://onlinelibrary.wiley.com/doi/10.1002/ccd.70457