Open Pulmonary Valvotonzy, Infundibular Resection and Trans Annular Patch : The pulmonary annulus may be narrow based on pre-operative investigations and on measurement with Hegar's dilator after valvotomy. The pulmonary arteriotomy incision is extended across the annulus on to the infundibular for 2 or 3 cms. Pulmonary valve cusps are excised leaving the posterior cusp, if it is normal. Hypertrophied infundibular muscle is excised. 111 babies, this resection- is kept to a minimum. A fresh or gluteraldehyde treated pericardial patch is then sutured to the right ventriculas outflow using 5 '0' prolene sutures.