With surgical repair most children with Tetralogy of Fallot survive into adulthood. The main complications seen after Tetralogy of Fallot repair include arrhythmias, sudden cardiac death, pulmonary regurgitation, and right ventricular dysfunction/heart failure. Pulmonary regurgitation over time may lead to right ventricular dilation and failure. In this article, we will review the literature regarding management of pulmonary regurgitation with specific focus on timing for pulmonary valve replacement and prevention of right ventricular dysfunction.