To the Editor:Tetralogy of Fallot (TOF) was first surgically repaired in 1955.Initial TOF repairs were performed using a trans-annular right ventricular outflow tract patch to relieve the obstruction.However,this procedure resulted in long-standing pulmonary valve regurgitation and increased right ventricular (RV) volume,causing arrhythmias and sudden death.[1] Thus,pulmonary annulus preservation became the most prevalent surgical strategy for TOF repair,possibly causing a mix of pulmonary stenosis and pulmonary valve regurgitation.