Enlargement of mitral valvular ring. New technique for double valve replacement in children or adults with small mitral anulus.

The technical difficulty of inserting a sufficiently large prosthesis in a small mitral ring has been overcome by a new technique based on the principle of complete division of the valvular ring and its unrestricted enlargment by reconstruction of the prosthetic valve. Th technique entails division of the aortic valvular ring into and through the mitral anulus and the left atrial wall. It provides wide exposure for easy double mitral and aortic valve replacement, which is performed with large prosthetic valves that are supported in part by the patch reconstruction of the incised structures. This method has been used with excellent technical and good early functional results in two children needing double valve replacement for rheumatic mitral and aortic regurgitation. A wider adoption of this technique to manage similar lesions in both children and adults seems advisable.