Nonvalve transannular patch repair of right ventricular outflow tract obstructive (RVOTO) defects results in pulmonary insufficiency, which can contribute to early postoperative right ventricular dysfunction. In both animal and clinical studies, monocusp valves provide perioperative RVOT competence and improved right ventricular functional characteristics. In these reports, monocusp leaflet construction with 0.1-mm polytetrafluoroethylene (PTFE) appeared equal, or superior, to biologic monocusp valves. Construction of the polytetrafluoroethylene monocusp valve is an inexpensive and straightforward way to create a competent RVOT in a variety of RVOTO anomalies. Based on our clinical experience, it effectively prevents short-term and significantly reduces midterm pulmonary insufficiency without evidence of stenosis.