Figure 2:

(A) The custom-made bovine pericardium ring used to close the gap between the endovalve and the calcified mitral annulus to avoid paravalvular leakage. (B) Final outcome of using the sutured pericardial patch to close the paravalvular leakage area around the endovalve, resulting in a perfect water test. (C) Postoperative echocardiography shows the perfect positioning of the mitral Edwards valve without any paravalvular leakage. The chest X-ray shows both the aortic and mitral bioprosthetic valves.