Angiograms demonstrating (A) preimplantation conduit obstruction and PR and (B) relief of obstruction and a competent valve after TPV. This patient with tetralogy of Fallot and pulmonary atresia had a primary indication of PR assigned on the basis of preimplantation echocardiography, which showed severe PR and a mean echocardiographic RVOT gradient of 18 mm Hg, although the directly measured RVOT gradient was 60 mm Hg at the time of catheterization. At the 2-year follow-up, there was no stent fracture, no PR, and a mean Doppler RVOT gradient of 11 mm Hg. C, Preimplantation mean Doppler RVOT gradient and echocardiographic PR grade are depicted in each patient according to the site-determined primary implantation indication: RVOT obstruction (solid red circles), PR (solid blue triangles), or mixed PR and obstruction (open purple circles). Patients of all NYHA classes are depicted; thus, some patients with moderate PR and a gradient >40 mm Hg are in the mixed indication category (NYHA class II or higher), and others are in the RVOT obstruction category (NYHA class I).