Tetralogy of Fallot is a common congenital cyanotic heart disease. Correction in infancy offers good interim results with minimal morbidity. The aims of the surgery at initial repair is to obtain adequate pulmonary circulation by relieving pulmonary stenosis. This often requires augmenting the right ventricular outflow tract (RVOT) with a Trans-annular Patch. All patients who undergo a trans-annular patch develop pulmonary valve incompetence after repair, following relief of pulmonary stenosis.

Longstanding pulmonary regurgitation (PR) has been shown to have deleterious effect on right ventricle (RV) size and function, resulting in an increased risk for severe arrhythmias and sudden death. Exercise capacity is often diminished in patients with severe dilatation of the RV. In the last few years techniques to preserve the valve have developed and 80 % of these children get competent valves at the end of the procedure.