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Our study presented several promising modulators, both DEGs and DEmiRNAs, as well as possible pathological pathways for AAD, which narrows the scope for further fundamental research. Adults with unrepaired tetralogy of Fallot (ToF) are common in developing countries. Long-term overload of the right ventricle places adult patients at risk for postoperative right heart failure after primary repair, which contributes to morbidity and mortality. The effect of pulmonary valve replacement (PVR) in reducing postoperative morbidity and mortalit