A modification to the Manouguian aortoplasty for biological valve implantation in patients with small (< or =19 mm) aortic anuli--rationale and benefit.

Enlargement of a small aortic root using the Manouguian technique for biological valve implantation can be challenging when rigid, severely calcified noncoronary parts of the aortic anulus are encountered in combination with outsized heights of interleaflet triangles. To maximize the efficacy of the Manouguian technique, we applied a modification--the rationale, technical details, and benefits of which we describe herein.