Table 1 Repaired tetralogy of Fallot and significant pulmonary regurgitation*: indications for pulmonary valve replacement.

Compelling	Subjective ↓ in exercise ability
	Sustained objective ↓ in exercise capacity
	Symptomatic VT/syncope
	Sustained VT on 24 hour ECG monitoring
	Serial RV dilatation/↓ in RV ejection fraction
	Increasing RV end‐systolic volume
	Onset tricuspid regurgitation with RV dilatation or atrial arrhythmias
Strong	QRS >180 ms or serial increase in QRS duration
	Surgery indicated for other reason (for example, residual VSD)
	Pregnancy contemplated
Debatable	RV volume >170 ml/m2
	150 ml/m2
	Patient preference

*Pulmonary regurgitation fraction >30%.

RV, right ventricle; VSD, ventricular septal defect; VT, ventricular tachycardia.