Etiology: The most common etiology is the enlargement of the annulus secondary to root dilatation of the pulmonary trunk due to pulmonary hypertension, such as primary pulmonary hypertension and Eisenmenger syndrome; rarely, the annulus enlarges due to idiopathic or Marfan syndrome pulmonary artery dilatation; and pulmonary valve injury after radical surgery for tetralogy of Fallot. Pathophysiological changes: pulmonary valve insufficiency causes right ventricular volume overload, which can be tolerated for many years if there is no pulmonary hypertension; if there is pulmonary hypertension, it accelerates the occurrence of right ventricular failure. Shandong University Qilu Hospital, Department of Cardiac Surgery, Gu Xinghua 3. Treatment: Treatment of the primary disease causing pulmonary hypertension or primary pulmonary hypertension is generally the main focus. This article focuses on the treatment of severe pulmonary valve closure insufficiency after radical surgery for TOF Some patients with tetralogy of Fallot undergo radical surgery, which requires the application of transvalvular ring patches to widen the right ventricular outflow tract and pulmonary artery trunk, inevitably damaging the pulmonary valve and causing pulmonary valve closure insufficiency. In some infants and children, pulmonary regurgitation tends to worsen with age after surgery. The management of postoperative severe pulmonary valve closure insufficiency with right heart insufficiency remains a difficult problem. 1. Treatment: pulmonary valve replacement. (2) Indications for surgery: (1) Severe pulmonary regurgitation with one of the following: intolerance to exercise, progressive right ventricular enlargement, persistent atrial flutter/atrial fibrillation/ventricular tachycardia with syncope (2) Moderate-to-severe pulmonary regurgitation with severe right ventricular enlargement with/without right heart decompensation/tricuspid regurgitation/ventricular or supraventricular tachycardia. 3, The most common choice of valve is a homogeneous allograft with valve conduit, followed by biological valve, mechanical valve, and pulmonary valve stent. The advantages and disadvantages of the first three valves, their placement methods, and long-term effects have been clarified in many studies and will not be repeated. 4, artificial pulmonary valve stent: In 2000, Bonhoeffer et al. first used an interventional method to insert a stent with a valve into the pulmonary valve for a 12-year-old patient with right ventricular outflow tract stenosis and pulmonary valve insufficiency, which was successful. 2008, Lurz et al. analyzed 155 patients with percutaneous prosthetic pulmonary valve stent placement (PPVI) and found that Most clinical symptoms improved after surgery, and activity tolerance increased significantly. The main indications are: (1) symptomatic patients with severe postoperative pulmonary regurgitation with right heart insufficiency and/or right ventricular dilatation; (2) patients with severe postoperative pulmonary regurgitation and sufficient evidence of right heart insufficiency without symptoms but with reduced exercise tolerance. Types of valve stents: application of balloon-expandable platinum-iridium alloy stents with valves and self-expanding nickel-titanium alloy stents with valves. Another method of placement: a valved stent is placed in the right ventricular outflow tract via the right ventricle under secondary open-heart, non-extracorporeal circulation, with additional fronts proximal and distal to the valve for fixation. Although there are several approaches to improve the quality of life of patients, all have certain drawbacks, so the treatment of severe pulmonary valve insufficiency remains an unresolved problem.