MAUDE Adverse Event Report: MEDTRONIC HEART VALVES DIVISION CONTEGRA; PULMONIC VALVED CONDUIT

Model Number	200H12
Medical Device Problem Codes	Gradient Increase (1270); Device Stenosis (4066); Intravalvular regurgitation (4068)
Health Effect - Clinical Codes	Stenosis (2263); Pulmonary Valve Insufficiency/ Regurgitation (4452); Insufficient Information (4580)
Date of Event	05/23/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
Medtronic received information that 2 months post implant of this 12mm pulmonary valved conduit implanted in a then 3-month-old pediatric patient, it was reported that the patient had developed progressive bilateral branch pulmonary artery stenosis with an elevated right ventricle pressure.The patient was referred for cardiac catheterization.Subsequently, 12 days later, cardiac catheterization was performed including stent angioplasty of the left pulmonary artery and balloon angioplasty of the right pulmonary artery.It was also reported that the previous gradient of 43-47mmhg reduced to 25mmhg.No additional adverse patient effects were reported.
Additional Manufacturer Narrative
Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Additional Manufacturer Narrative
Updated a4 medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Additional Manufacturer Narrative
Updated data: b.2: outcome attributed to adverse event b.5: event description h.6: coding medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
Additional information was received that a follow-up echocardiogram discovered severe pulmonary regurgitation of the conduit.No intervention or additional adverse patient effects were reported.
Additional Manufacturer Narrative
B5 updated.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
Additional information was received that on (b)(6) 2026, the patient underwent cardiac catheterization which demonstrated restenosis of the existing left pulmonary artery (lpa) stent.It was further reported that balloon angioplasty and a placement of second stent was performed with significant angiographic improvement and trivial residual gradient.It was further noted during a follow up on (b)(6) 2026, the patient was doing well, with a follow-up planned for (b)(6) 2026.No additional adverse patient effects were reported.

• Brand Name: CONTEGRA
• Common Device Name: PULMONIC VALVED CONDUIT
• Manufacturer (Section D): MEDTRONIC HEART VALVES DIVISION; 1851 e deere ave; santa ana CA 92705
• Manufacturer (Section G): MEDTRONIC HEART VALVES DIVISION; 1851 e deere ave; santa ana CA 92705
• Manufacturer Contact: alison sweeney ; parkmore business park west; galway ; EI ; 091708096
• MDR Report Key: 21172487
• Report Number: 2025587-2025-00451
• Device Sequence Number: 4538699
• Product Code: MWH
• UDI-Device Identifier: 00643169616899
• UDI-Public: (01)00643169616899(17)240824(21)D679030
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: H020003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 06/02/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 08/24/2024
• Device Model Number: 200H12
• Device Catalogue Number: 200H12
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/26/2024
• Supplement Date Received by Manufacturer: 01/27/2025; 04/10/2025; 05/14/2026
• Initial Report FDA Received Date: 01/16/2025
• Supplement Report FDA Received Date: 02/19/2025; 05/05/2025; 06/02/2026
• Date Device Manufactured: 08/25/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Life Threatening
• Patient Age: 5 MO
• Patient Sex: Male
• Patient Weight: 6 KG