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Figure 5: En bloc rotation of outflow tracts (half-turned truncal switch). (a) The aorta was located anteriorly, and the main pulmonary artery was located posteriorly. The aorta was transected 10 mm above the coronary orifices. (b) Antero–superior view of the truncal root. The dotted line indicates the incised line. The supposed incised line on the main pulmonary artery runs obliquely from the posterior wall of the pulmonary annulus to the anterior wall of the pulmonary bifurcation. (c) The main pulmonary artery was incised obliquely so as to keep the anterior wall to the proximal side. Both coronary arterial buttons were resected. (d) Along the aortic annulus, the anterior wall of the right ventricle was incised. The dotted line indicates the incised line on the infundibular septum. (e) The midline of the fibrous continuity between the pulmonary valve and the mitral valve was incised. The truncal block involving both semilunar valves was separated from the ventricular outflow tract. The resected truncal block was half turned. (f) The half-turned truncal block was anastomosed to the ventricular outflow tract. First, the posteriorly translocated aortic annulus was anastomosed to the left ventricular outflow orifice. The up-front pulmonary commissure was cut through. (g) After anastomosis of the aortic annulus, both coronary buttons were anastomosed to the corresponding defects of the aortic wall. The ventricular septal defect was closed with an expanded polytetrafluoroethylene patch (ventricular septal defect patch). The superior margin of the patch was anastomosed to the prominence of the infundibular septum. (h) After the pulmonary bifurcation was translocated anteriorly, the ascending aorta was reconstructed by means of end-to-end anastomosis. Continuity of the posterior pulmonary wall was reconstructed by means of direct anastomosis with each remnant wall. (i) The right ventricular outflow tract was covered with an autologous pericardial patch (right ventricular outflow tract patch) equipped with a monocusp expanded polytetrafluoroethylene valve (reproduced with permission from Yamagishi et al.[37])

Figure 5: En bloc rotation of outflow tracts (half-turned truncal switch). (a) The aorta was located anteriorly, and the main pulmonary artery was located posteriorly. The aorta was transected 10 mm above the coronary orifices. (b) Antero–superior view of the truncal root. The dotted line indicates the incised line. The supposed incised line on the main pulmonary artery runs obliquely from the posterior wall of the pulmonary annulus to the anterior wall of the pulmonary bifurcation. (c) The main pulmonary artery was incised obliquely so as to keep the anterior wall to the proximal side. Both coronary arterial buttons were resected. (d) Along the aortic annulus, the anterior wall of the right ventricle was incised. The dotted line indicates the incised line on the infundibular septum. (e) The midline of the fibrous continuity between the pulmonary valve and the mitral valve was incised. The truncal block involving both semilunar valves was separated from the ventricular outflow tract. The resected truncal block was half turned. (f) The half-turned truncal block was anastomosed to the ventricular outflow tract. First, the posteriorly translocated aortic annulus was anastomosed to the left ventricular outflow orifice. The up-front pulmonary commissure was cut through. (g) After anastomosis of the aortic annulus, both coronary buttons were anastomosed to the corresponding defects of the aortic wall. The ventricular septal defect was closed with an expanded polytetrafluoroethylene patch (ventricular septal defect patch). The superior margin of the patch was anastomosed to the prominence of the infundibular septum. (h) After the pulmonary bifurcation was translocated anteriorly, the ascending aorta was reconstructed by means of end-to-end anastomosis. Continuity of the posterior pulmonary wall was reconstructed by means of direct anastomosis with each remnant wall. (i) The right ventricular outflow tract was covered with an autologous pericardial patch (right ventricular outflow tract patch) equipped with a monocusp expanded polytetrafluoroethylene valve (reproduced with permission from Yamagishi <i>et al</i>.<sup>[37]</sup>)