With the increase of adult patients who need repeated surgery long after definitive repair of congenital heart defects in their childhood, right ventricular outflow tract reconstruction (RVOTR) is gaining more importance. From the viewpoint of timing and indication of surgical intervention, early primary repair and annulus preserving procedure have been the 2 current standards of RVOTR;however, long term outcome of both procedures has to be determined by further study. Although a wide variety for materials are used for pulmonary valve replacement in RVOTR, deficient longevity is one of the most common problems, especially when used for young patients mainly due to immunological rejection. In our institute, we originally developed and manufactured expanded polytetrafluoroethylene (ePTFE) valved patches/conduits, which showed excellent clinical results in a former multicenter study in Japan. This improved outcome may partly be attributable to the biocompatibility and low antigenicity of ePTFE and also to the fluid dynamical properties arising from the 2 characteristic structures:bulging sinus and fan-shaped valve. However, to achieve better patients prognosis with good quality of life,there still remains a lot of problems to be solved concerning RVOTR, such as indication and timing of definitive repair and choice of materials for pulmonary valve replacement. This review describes recent surgical strategies and remaining problems of RVOTR.