Konno-Rastan Combined with Manougiaun Root Enlargement for Small Aortic Root with Coronary Anomaly in a Young Woman

Aortic root enlargement (ARE) is an established procedure to deal with small aortic annulus. It becomes very important to place adequate size prosthesis to prevent patient–prosthesis mismatch (PPM). Aortic root enlargement procedures procedures are technically demanding operations, particularly in obese patients. The presence of coronary artery anomalies adds more complexity to the procedure. We present an interesting case of a 22-year-old obese female with symptomatic severe aortic valve stenosis and anomalous coronary arteries. We successfully performed aortic valve replacement using the combined Konno aortoventriculoplasty and Manouguian posterior aortic root enlargement. Combined aortic root enlargement techniques techniques should be considered in the presence of major coronary anomalies.