Background: Pulmonary valve disease is a common component of congenital heart disorders, particularly Tetralogy of Fallot (TOF), pulmonary stenosis (PS), and postoperative right ventricular outflow tract (RVOT) dysfunction. Advances in catheter-based interventions, such as balloon pulmonary valvuloplasty (BPV) and transcatheter pulmonary valve implantation (TPVI), have reduced surgical burden in pediatric cases and improved long-term outcomes. Objective: This study evaluates clinical outcomes, selection criteria, and comparative effectiveness of surgical versus transcatheter pulmonary valve interventions in pediatric congenital cases. Methods: A retrospective cohort review was conducted on 214 pediatric patients (<18 years) treated between 2018–2023 across three regional cardiac centers. Primary outcomes included mortality, reintervention rate, RV pressure reduction, and valve competency. Secondary outcomes included hospital stay, procedural complications, and growth-related valve performance. Results: BPV was performed in 148 patients (69%), TPVI in 36 patients (17%), and surgical repair in 30 patients (14%). Immediate post-procedural RV systolic pressure decreased significantly in BPV patients (p<0.01), with 5-year reintervention rates of 18%. TPVI demonstrated superior valve competency and lower regurgitation but higher procedural cost and device-related complications. Surgical cases showed higher morbidity and longer hospital stays but remained necessary for patients with complex RVOT anatomy or multilevel stenosis. Conclusion: Catheter-based pulmonary valve interventions offer effective and less invasive options for pediatric congenital cases, with TPVI emerging as a durable alternative to repeat surgery. Early selection, anatomical suitability, and long-term follow-up remain critical for optimizing outcomes.