Fig. 2

A In vivo picture of the quadricuspid truncal valve. B and C The diseased cusps are removed. D Neo-leaflets with a trapezoid-shaped base and a tapered fan-shaped top are tailored using autologous pericardium. The lengths of the base and side are determined based on the excised margin of two cusps (a) and the height from the sino-tubular junction to the stump of the truncal root (b). The angle from the base to the side is adjusted to approximately 120°. E The base of the posterior neo-leaflet is anastomosed continuously along the margin of the two posterior cusps. Both sides of the posterior neo-leaflet are sutured at the truncal wall from the commissures toward the stump of the truncal root. F The base of the anterior neo-leaflet is sutured at the two anterior cusps. G Both sides of the anterior neo-leaflet are secured by suturing both the aortic wall and posterior neo-leaflet to create the neo-commissures. H Schematic view of the reconstructed truncal valve