Schematic view of the V-Plasty Technique. a- General view of the pulmonary arteriotomy. b- Anterior leaflet incision starting point. c- Anterior leaflet of the pulmonic valve is incised longitudinally in midcusp line from 1-2 mm below the native free margin to the pulmonary annulus. After the incision, incised anterior leaflet forms a V shape. d- Shape of the pericardial patch which will be used for enlargement of the anterior leaflet. e- Annulus and anterior leaflet enlargement achieved with a pericardial patch. Suturing of the patch started at the level of the pulmonary annulus and continued through the free margin of the anterior leaflet. f- Construction of a new pulmonary sinus over anterior leaflet with a second patch which is bigger than the first one.