How is a small aortic annulus or root handled when doing aortic valve replacement? do the 19mm or 17mm valves flow badly? more risks?

Cardiac surgeon: Small aortic annulus is identified by echocardiography. Your cardiac surgeon will plan to enlarge the annulus to accommodate the largest valve practical. Sometimes even cutting into the heart like a ross/konno is required. All surgery has risks but your surgeon will be everything possible to help you, remember they have dedicated themselves to this job. Hope this helps.

Enlargement: In an average sized person, the smaller the implanted vale, the higher the residual flow gradient across the valve. This translates into higher cardiac work. The way around this is to enlarge the aortic root. There are multiple techniques for this, which are very effective. All of the valves work well, but the smaller the valve, the higher the gradient.