Patients with an increase in PR or PS should have fluoroscopic or x-ray assessment to rule out stent fracture. Annualized rate of IE is up to 2.4% of patients treated with Melody valve implantation, but in- fection in most cases involves valves other than the Melody valve, including left-sided valves.S4.3.6-3, Patients typically present with fever and malaise as well as worsening PS or PR. Cases may respond well to medical management with intravenous antibiotics if IE is identified and treatment initiated early in the disease course, although sometimes surgical removal of the valve may be necessary. 3. Although noninvasive imaging with echocardiog- raphy, CMR, or CTA provides a reasonably com- prehensive assessment of ventricular function, conduit function, and patency as well as pulmo- nary arterial anatomy, cardiac catheterization is reasonable to directly assess hemodynamics in the setting of clinical decompensation. Direct assessment of intracardiac and pulmonary arterial pressures and cardiac output provides useful infor- mation regarding volume status, pulmonary arte- rial resistance, and degree of conduit stenosis or regurgitation. Because of anatomic and technical factors, noninvasive imaging may provide equiv- ocal information and may underestimate the de- gree of conduit stenosis or regurgitation; invasive assessment is especially important in such cases. 4. Right ventricle to-PA conduit intervention includes surgical replacement or percutaneous stenting and/or transcatheter valve placement. Patients with moderate or greater conduit stenosis (Table 22) and/or regurgitation who have reduced exercise capacity or arrhythmias can benefit from surgical Table 28. Right Ventricle to-PA Conduit: Routine Follow-Up and Testing Intervals Frequency of Routine Follow-Up and Testing Physiological Stage A* (mo) Physiological Stage B* (mo) Physiological Stage C* (mo) Physiological Stage D* (mo) Exercise test As needed As needed 12 24 12 24 *See Tables 3 and 4 for details on the ACHD AP classification system. 