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A14-year-old male with degeneration of his right ventric-ular to pulmonary artery homograft conduit was referred to us for percutaneous pulmonary valve implantation (PPVI). 1 Magnetic resonance imaging indicated close proximity of the left anterior descending coronary artery to the homograft (Figure, A). To test whether PPVI would compress the coronary artery, an 18-mm Mullins balloon (NuMed Inc, Hopkinton, NY) was inflated within the homograft, bringing it to its maximum diameter and mimicking stent implantation. Simultaneous selective coronary angiography demonstrated significant compression of the left anterior descending coronary artery (Figure, B). The balloon was deflated, after which normal coronary flow was restored (Figure, C), and thus PPVI was not performed. The patient was referred for surgery.