Right ventricular angiogram in tetralogy of fallot

The RV angiogram in a patient with tetralogy of Fallot was obtained with the camera angled cranially and in a slight left anterior oblique projection. The subvalvar (*) obstruction is so severe that with systole, there is absence of contrast in the RV outflow tract. The pulmonary valve annulus is small with a thickened valve. There is a small ridge of supravalvar narrowing (black arrow) and mild proximal LPA stenosis (red arrow).