(See Section 4.3.6. for recommendations regarding evaluation and management of right ventricle to-PA conduits.) COR LOE Recommendations Diagnostic I B-NR CMR is useful to quantify ventricular size and function, pulmonary valve function, pulmonary artery anatomy, and left heart abnormalities in patients with repaired I B-NR Coronary artery compression testing is indicated before right ventricle to-PA conduit stenting or transcatheter valve placement in repaired TOF.S4.3.5-2 IIa B-NR Programmed ventricular stimulation can be useful to risk-stratify adults with TOF and additional risk factors for SCD.S4.3.5-3 S4.3.5-8 IIa C-EO In patients with repaired TOF, cardiac catheterization with angiography, if indicated, is reasonable to assess hemodynamics when adequate data cannot be obtained noninvasively in the setting of an arrhythmia, HF, unexplained ventricular dysfunction, suspected pulmonary hypertension or cyanosis. Therapeutic I B-NR Pulmonary valve replacement (surgical or percutaneous) for relief of symptoms is recommended for patients with repaired TOF and moderate or greater PR with cardiovascular symptoms not otherwise IIa B-NR Pulmonary valve replacement (surgical or percutaneous) is reasonable for preservation of ventricular size and function in asymptomatic patients with repaired TOF and ventricular enlargement or dysfunction and moderate or greater IIa B-NR Primary prevention ICD therapy is reasonable in adults with TOF and multiple risk factors IIb C-EO Surgical pulmonary valve replacement may be reasonable for adults with repaired TOF and moderate or greater PR with other lesions requiring surgical interventions. IIb C-EO Pulmonary valve replacement, in addition to arrhythmia management, may be considered for adults with repaired TOF and moderate or greater PR and ventricular tachyarrhythmia. Synopsis Long-term survival after surgery for TOF continues to improve. However, residual hemodynamic and electro- physiological abnormalities are common in adulthood. 