Objective: Complications of percutaneous pulmonary valve implantation (PPVI) remain underreported. We report treatment of recurrent right ventricular outflow tract (RVOT) obstruction and discuss management of a dislodged valve during PPVI. Methods: A 36-year-old female with Tetralogy of Fallot and five previous sternotomies presented with progressive dyspnea. TEE revealed preserved ejection fraction (50-55%), severe pulmonic stenosis (mean gradient: 26-mmHg; peak gradient: 60-mmHg), and regurgitation. She underwent PPVI using a 23-mm Sapien valve. Initial deployment was unsuccessful, resulting in a free-floating valve in the right ventricle (RV). A second oversized percutaneous valve was positioned more distally, deployed with extra balloon dilatation. Second deployment was successful with RVOT gradient relief. The floating valve was then addressed. Two techniques were attempted: “jailing” and “snare-and-crush” (Figure 1A and 1B). Although snaring was successful and the valve pulled into the inlet of the RV, crushing proved difficult. No further attempt was made due to possible tricuspid valve damage. The patient was converted to a fourth-time redo-sternotomy with retrieval of the valve (Figure 1C). Her post-op course was uneventful. Results: Detachment of the initial valve resulted from landing zone miscalculation. In second valve placement, more distal deployment and sizing to a 29-mm valve allowed for better stabilization. Although the accordion-style metal frame of the valve lends itself to a snare-and-crush approach, this proves difficult in practice. Another impediment to successful percutaneous retrieval lies in the complex tricuspid sub-valvar apparatus and potential iatrogenic injury. Conclusions: PPVI is important in managing recurrent cyanotic congenital disease. Reporting of complications is important to minimize risk and understand management strategies. We report on careful assessment of the landing zone and discuss useful strategies to manage valve dislodgement.