*Symptoms may include dyspnea, chest pain, and/or exercise intolerance referable to PR or otherwise unexplained. See recommendation 6 supporting text. ACHD indicates adult congenital heart disease; HF, heart failure; LV, left ventricular; LVEDV, left ventricular end diastolic volume; PR, pulmonary regurgitation; RV, right ventricular; RVEDV, right ventricular end diastolic volume; RVEDVI, right ventricular end diastolic volume index; RVESVI, right ventricular end systolic volume index; RVOT, right ventricular outflow tract; RVSP, right ventricular systolic pressure; and TOF, tetralogy of Fallot. CLINICAL STATEMENTS AND GUIDELINES a diagnostic and treatment algorithm for repaired TOF with residual PR; and Table 27 for routine testing and follow-up intervals. Recommendation-Specific Supportive Text 1. Cardiac magnetic resonance imaging is the gold standard imaging modality for quantification of right ventricular size and function in patients with repaired TOF. It also allows for quantification of valve regurgitation and pulmonary and sys- temic flows as well as delineating pulmonary ar- tery anatomy and detection of scar tissue in the ventricular myocardium. Serial cardiac magnetic resonance imaging examinations allows for longi- tudinal follow-up of patients with repaired TOF and provides useful information that aids in the timing of pulmonary valve replacement.S4.3.5-1,S4.3.5-34 S4.3.5-37 2. Before any surgical or percutaneous intervention in patients with TOF, the origins and proximal courses of the coronary arteries should be delin- eated. Patients with repaired TOF and abnormal coronary artery anatomy have a substantial risk of coronary artery compression during percuta- neous pulmonary valve replacement or direct in- jury to the coronary during surgical pulmonary valve replacement. During cardiac catheteriza- tion, the coronary pattern may be demonstrated by performing simultaneous RVOT angiography and coronary angiography.S4.3.5-2 Coronary com- pression testing generally involves simultaneous coronary angiography or aortography and bal- loon dilation of the RVOT to ascertain whether a balloon expanded stent will compress the cor- onary artery. 3. 