{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:17:49Z","timestamp":1770977869350,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Right ventricular outflow tract (RVOT) reconstruction is frequently performed for pediatric patients with pulmonary valve anomalies, yet optimal techniques remain debated. The equine pericardium offers a promising substrate for pulmonary valve reconstruction but has been understudied in pulmonary valve reconstruction. This study evaluated a novel technique using the equine pericardium to create a cylinder bicuspid pulmonary valve for RVOT reconstruction. Methods: In this retrospective cohort study, 17 pediatric patients (median age: 10 months; 53% male) underwent RVOT reconstruction with equine pericardium between 2023 and 2024. The valve was fashioned from a patch of equine pericardium into a cylinder to create a functionally bicuspid valve. The height of the cylinder ranged from 1.5\u20132 cm. The diameter was measured around a Hegar dilator corresponding to a valve size z-score of +3. The outcomes included the degree of postoperative pulmonary regurgitation, RVOT pressure gradients, postoperative complications, and reinterventions. Results: Postoperatively, the median peak RVOT pressure gradient decreased significantly from 70 mmHg (IQR: 65\u201390) to 25 mmHg (IQR: 20\u201340; p &lt; 0.001). Mild pulmonary regurgitation persisted in one patient (5.9%). Five patients had mild right ventricular dysfunction (29.41%). At a median 3-month follow-up (IQR: 1\u20138), 17.7% (n = 3) underwent cardiac catheterization. There was no postoperative mortality. Conclusions: Cylinder bicuspid pulmonary valve reconstruction using the equine pericardium effectively reduces RVOT obstruction while maintaining pulmonary valve competence and demonstrates acceptable short-term safety. Having a competent pulmonary valve after repairing the hypoplastic pulmonary valve annulus is very promising; however, the small cohort and limited follow-up preclude definitive conclusions about long-term durability. Larger prospective studies with longer follow-up periods are needed to validate this technique for RVOT reconstruction.<\/jats:p>","DOI":"10.3390\/jcm15041457","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T17:42:13Z","timestamp":1770918133000},"page":"1457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cylinder Bicuspid Pulmonary Valve Reconstruction Using Equine Pericardium: A Novel Technique for Right Ventricular Outflow Tract Repair"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7678-5700","authenticated-orcid":false,"given":"Ahmed F.","family":"Elmahrouk","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia"},{"name":"Cardiothoracic Surgery Department, Tanta University, Tanta 31527, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0965-5797","authenticated-orcid":false,"given":"Abdelmonem M.","family":"Helal","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah 23433, Saudi Arabia"},{"name":"Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo 12613, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad F.","family":"Babgi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiac Center, King Abdullah Medical City, Makkah 24246, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7356-7679","authenticated-orcid":false,"given":"Abdulbadee","family":"Bogis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3005-2093","authenticated-orcid":false,"given":"Amjad A.","family":"Kouatli","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah 23433, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0481-4442","authenticated-orcid":false,"given":"Mohammad S.","family":"Shihata","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, X., Bakhuis, W., Veen, K.M., Bogers, A.J.J.C., Etnel, J.R.G., van Der Ven, C.C.E.M., Roos-Hesselink, J.W., Andrinopoulou, E.-R., and Takkenberg, J.J.M. 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