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Approximately 5% of percutaneous pulmonary valve implantation are at risk for coronary compression. Therefore, PPVI is contra-indicated if coronary anomalies and tested coronary flow impairment are observed. Simultaneous right ventricular outflow tract ballooning and coronary angiography are mandatory elucidating contraindications for PPVI. We present the case of a 22-year-old young lady following Rastelli repair with chronic right heart failure. Weighing the risk of several offered surgical options, she underwent successful PPVI follo