Abstract
A very small aortic root and annulus (≤17 mm) needs extensive aortic annular enlargement in adult patients. This report describes a technique that enlarged the aortic annulus by 5 valve sizes from 16 to 17 mm to size 27 bovine pericardial valve, as well as a modification of the aortotomy with the roof technique to make the aortotomy closure easier and more hemostatic while enlarging the sinotubular junction and proximal ascending aorta effectively for future valve-in-valve transcatheter aortic valve replacement.
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