When implanted in young adults, DAHs seem to remodel parallel with the physiological development of the body as shown by the z-value development of implanted grafts. However, in patients receiving very small grafts, we observed a tendency towards a gradient increase over time. This to our understanding suggests that, in very young patients, who are rapidly growing, isolated replacement of the aortic valve using DAHs without enlargement of the LVOT might not be adequate. Congenital, multi-level LVOT obstruction, as well as stenosis of the ascending aorta, requires adequate graft diameters and length, but may also necessitate a supplementary surgical approach to enlarge the LVOT. Results after the use of the conventional aortic homograft in this special patient group are scarcely published. Ross or Ross-Konno procedures are commonly used for the treatment of severe anomalies of the aortic valve with LVOT obstruction [22, 23]. However, these procedures harbour several disadvantages, including placing two semilunar valves at risk in an originally single-valve disease, risk of dilatation of the pulmonary autograft and pre-programmed reoperation rates for pulmonary homograft exchange during childhood.