Echocardiographic follow up:
All included patients underwent Intraoperative transesophageal echocardiogram (TEE) as well as a routine pre-discharge TTE (first post-operative echocardiogram). Patient follow-up and need for reintervention were determined from the outpatient clinic charts. The TTE was performed regularly in the outpatient setting to assess the pressure gradient across the main pulmonary artery and the pulmonary artery branches. In our center the follow up protocol is to do TTE after 6 weeks, 3 months, 6 months, 1 year of discharge, then once yearly unless there are pathologic changes in first year of follow up. Follow up was available for all patients at a mean duration of 9.3 years. the follow-up included for the purpose of this study, the valvular function and the pulmonary artery pressure gradient.