Objective: Aortic stenos is with narrow aortic root is a rare presentation. Posterior aortic root enlargement and anterior aortic root enlargement individually have their own limitations. We present our experience combining both procedures in cases where single procedure of root enlargement is not sufficient. By both anterior and posterior root enlargement, we successfully could insert an adult size mechanical prosthesis with minimal morbidity and no mortality in paediatric patients.

Materials and Methods: we report our experience with three cases with small aortic root, allowing the implantation of only 15mm size aortic valve, initially. Posterior enlargement allowed implantation of 17mm valve, but, using a combined approach, a maximum size of 21mm aortic valve could be implanted.

Results: All the three cases had an uneventful postoperative period with relief of symptoms and significant reduction in postoperative gradients with minimal morbidity and no mortality.

Conclusion: Combined aortic root enlargement allows insertion of an adult size prosthesis and has been found to minimize the chance of Patient Prosthetic Mismatch and the morbidity associated with a redo surgery in paediatric cases and is demonstrated to be safe and feasible with improvement in quality of life in patients with small aortic root with minimal morbidity and no mortality.