(A) En bloc resection of the area of confluence of the aortic root, the left atrial roof, the aorta mitral junction and the base of the anterior mitral leaflet with preservation of the free edge of the anterior mitral leaflet. (B) Reconstructed anterior mitral annulus and leaflet with a bovine pericardial patch folded upon itself. (C) Reconstructed left ventricular outflow tract after root replacement. The prosthetic aortic valve/root graft is anchored to the aortic annulus and neo-left ventricular outflow tract, as well as to the anterior limb of the pericardial patch. (D) Left atrial roof closure with a single pericardial patch.