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Percutaneous pulmonary valve implantation has emerged as an attractive and less invasive alternative to open‐heart surgery. Nevertheless, major technical challenges and procedural complications may still occur. We report a 44‐year‐old woman with severe dextroscoliosis, and history of Tetralogy of Fallot repair, who underwent an attempt at percutaneous implantation of a 23‐mm Edwards SAPIEN transcatheter heart valve (THV) for recurrent stenosis of the right ventricle to pulmonary artery conduit. The procedure was complicated by valve migration into the right ventricle requiring emergent surgical removal using inflow‐occlusion technique to avoid cardiopulmonary bypass. A hybrid off‐pump perventricular approach was then used in the operating room to successfully implant a 26‐mm Edwards Sapien THV under fluoroscopic guidance. © 2010 Wiley‐Liss, Inc.