When replacing the regurgitant tricuspid valve in children, the decision to use either a bioprosthesis or a mechanical valve remains controversial. The atrioventricular valve for the pulmonary circulation was replaced in 11 young patients aged 8 months to 13 years. Cardiac malformation was present in seven patients, Ebstein’s anomaly in three patients, and tricuspid valve regurgitation in one patient. A bioprosthesis was implanted on seven occasions, and a bileaflet mechanical valve on eight, including re-replacement of the valve in four patients. One patient died two years after implantation due to respiratory problems. Tricuspid stenosis due to valve calcification occurred in four bioprostheses at between four and nine years after initial replacement (57%). In three of these the native valve leaflets had not been removed. Thrombosis occurred in one patient with a mechanical valve (re-replacement was successful) and anticoagulant-related hemorrhage occurred in one patient. In patients receiving a mechanical valve, 83% of valves were dysfunction-free after five and ten years. In conclusion, when replacing an atrioventricular valve in children, a low-profile mechanical valve is preferred, especially when intracardiac malformation has been repaired, and ventricular function is good. In children with poor cardiac performance, a bioprosthesis is preferred, with total resection of the native valve leaflets.