Aortic valve replacement (AVR) in patients with a small aortic annulus may represent a surgical challenge. Although new generation heart valves especially stentless bioprosthesis minimize the need for aortic annulus enlargement procedures but there were some conditions that necessitate the aortic root enlarging method to implant a suitable size of prosthesis. We evaluated the midterm results of the Manouguian procedure as a simple method to aortic root enlargement
small aortic annulus
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