Narrow mitral annulus is a common situation faced in adult patients. Choice of prosthetic valve in such cases is unclear. There are reported experiences with supra-annular mitral valve, Manouguian technique, "chimney technique" with mechanical valve and Melody valve, the latter two being in children. We report a novel "bio-chimney" technique in which a bioprosthetic valve of a size appropriate for the patient is sutured to a polyester vascular graft, which is then implanted to the native narrow mitral annulus in an adult patient, with promising initial results.
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