**Abstract**

Pulmonary valve pathology occurs mostly in the settings of congenital heart disease whether primary or as the result of repair of a variety of congenital heart defects. Acquired pulmonary valve disorders, albeit rare, can occur in the settings of endocarditis, tumors, carcinoid syndrome, or rheumatic fever. Surgical options include repair and replacement of pulmonary valve. Several options for replacement are available, which can be tailored based on the patient's clinical profile and the primary valve pathology. In this chapter, we present the surgical options that are currently available for pulmonary valve disorders and the current outcomes.

**Keywords:** pulmonary valve replacement, endocarditis, carcinoid syndrome, congenital pulmonary valve stenosis, pulmonary regurgitation, bioprosthesis, mechanical prosthesis, Ozaki

### **1. Introduction**

A variety of congenital and acquired pathologies results in pulmonary valve (PV) disease that necessitates intervention. The types of this intervention depend on the main pathology with transcatheter options such as balloon valvuloplasty and transcatheter pulmonary valve implantation gaining popularity in the current era, especially in the congenital settings to delay the need for a sternotomy or repeat surgery. Surgical options include open valvotomy for congenital pulmonary valve stenosis and pulmonary valve repair or replacement for many other pathologies. Several replacement options are available currently such as homografts, bioprostheses, and mechanical prostheses with long-term data. Other novel techniques such as intra-operative reconstruction of pulmonary valve leaflets using autologous or bovine pericardium and creation of hand-made valved conduits are being used but no long-term data are available for these techniques.

The focus of this chapter will be on discussing the several surgical options that are currently used to repair or replace the pulmonary valve and the different surgical approaches that are being used with reviewing the literature regarding outcomes. Discussion of the various pathologies involving the pulmonary valve, or the right ventricular outflow tract, is beyond the scope of this chapter.
