Figure 2.

Aortas that should not be clamped. (A) Since mitral valve replacement was not possible safely without clamping, the aorta was replaced first under circulatory arrest and then the graft was clamped. Note the very normal looking homograft that was left alone as was the autograft (21 years post Ross). (B) This represents another aorta that was hostile as was the mitral annular calcification shown here—procedures were performed on the fibrillating heart without clamping.