*3.3.1 Autologous pericardial reconstruction (Ozaki)*

The autologous pericardium has been used for decades to create aortic and/or pulmonary valve leaflets (one or more) and more recently has been used to create three-leaflet aortic valves *via* standardized templates (Ozaki procedure) [4]. This procedure began in the adult population but has recently widely spread to the pediatric patients with aortic valve pathology with good initial and mid-term results in some series [5].

More recently, the same procedure has been used to create three-leaflet pulmonary valves for PVR (**Figures 2A–F** and **3**). Limited literatures are available for the Ozaki outcome in the pulmonary position and the majority of these are case reports using autologous pericardium [6] or bovine pericardium [7]. This was used in the setting of pulmonary artery aneurysm [8], endocarditis, and free pulmonary regurgitation after previous pulmonary valvotomy. We have utilized the Ozaki templates to create three leaflet pulmonary valves for an infant who was born with congenital pulmonary stenosis and hypoplastic annulus and in another child who underwent late repair of tetralogy of Fallot with pulmonary stenosis.
