Indications for Surgery : Patients usually present with fatigue, dyspnoea and ventricular arrhythmias. If they have additional tricuspid regurgitation, pulmonary valve replacement should be considered. After correction of Tetralogy of Fallot the progression of pulmonary regurgitation is time related and depends on other lesions like RV obstruction or residual ventricular septa1 defect.

In the Toronto experience, 1-2 per cent of patients after corrections of Tetralogy required re-operation after a mean interval of 12 years. 66 per cent of them had a trans annular patch and they required Pulmonary valve replacement.