Small aortic annuli are a challenge and a proper valve size is needed to avoid important prosthesis-patient mismatch, especially in case of multiple valves surgery.
We proposed a technique involving the use of Hegar dilators in the aortic position while replacing the mitral valve, in order to maintain the proper aortic diameter. We used this method on two patients and we found it easy and reproducible.
Gennari M, Agrifoglio M, Ricciardi G, Polvani G. Hegar-based method for aortic valve replacement in multiple valve surgery. J Cardiothorac Surg 2018 May 21;13(1):49.