1. Two-Directional Aortic Annular Enlargement for Aortic Valve Replacement in the Small Aortic Annulus 
Masaki Otaki, MD, Hidetaka Oku, MD, Susumu Nakamoto, MD, Hitoshi Kitayama, MD, Masao Ueda, MD, Terufumi Matsumoto, MD 
The Annals of Thoracic Surgery 
Volume 63, Issue 1, Pages (January 1997)
DOI: /S (96)

2. Fig. 1
The aortotomy was made obliquely toward the noncoronary sinus. After the aortic annulus was measured with dilators after removal of the aortic valve, posterior enlargement was performed according to the Nicks procedure (patients 1 and 2: isolated aortic valve replacement) or the Manouguian procedure (patient 3: aortic and mitral valve replacements) and then an additional anterior enlargement was made just to the commissure between the left and the right coronary cusps. Reconstruction of the annulus and repair of the aortotomy were obtained with a bifurcated Dacron patch.
The Annals of Thoracic Surgery  , DOI: ( /S (96) )