After the aortic cross clamping with a flexible clamp, the interatrial groove is dissected and the left atrium is incised. Periannular stitches are then implanted, keeping them superficial to avoid the circumflex artery, the aortic valve and the atrioventricular node. Two stitch are passed to suspend the posterior leaflet, a triangular portion of P2 is resected and the leaflet is reconstructed with 5/0 stitches. Then, the coaptation surface of the posterior and anterior leaflet is evaluated and a water test is performed to check the valvular continence.