Adult patients with postoperative massive regurgitation in the pulmonary valve in patients with tetralogy of Fallot can undergo minimally invasive prosthetic pulmonary valve implantation (PPVI). Based on the approximately 4,000 PPVI procedures performed worldwide, PPVI is generally safe, feasible, and effective. The indications are: (1) patients with moderate to severe PR (MRI >25%) with or without pulmonary stenosis or right ventricular outflow tract stenosis; (2) patients with symptoms, including decreased exercise tolerance, symptoms of right heart failure and associated arrhythmias (palpitations, black huan syncope, etc.); (3) asymptomatic patients with more than one of the following conditions: moderate tricuspid valve or greater (3) asymptomatic patients with one or more of the following: moderate or greater tricuspid regurgitation; right ventricular end-diastolic volume index >150 ml/m2; right ventricular end-systolic volume index >70 ml/m2; right ventricular ejection fraction <45%; QRS wave width >180 ms; aneurysmal dilatation of the right ventricular outflow tract; arrhythmias associated with right heart enlargement such as ventricular tachycardia, frequent premature ventricular events, atrial flutter, or atrial fibrillation; (4) anatomically appropriate right ventricular outflow tract pulmonary trunk with a diameter of 16 mm to 22 mm (this criterion is constantly changing with the improvement of valve stents).