Since March 1984 we have been using a new biological valve for aortic valve replacement in children. The valve substitute is an autologous segment of cylinder taken from the pulmonary arterial trunk, leaving untouched the bifurcation and the pulmonary valve. The pulmonary artery wall segment is sutured without stand to the brim of the aortic annulus and upward beyond the aortic commissures to achieve adequate support from the aortic wall. The pulmonary artery itself is reconstructed by direct suture. This procedure has been successfully used in 3 patients aged 7, 10 and 13 years presenting with severe aortic regurgitation due to rheumatic heart disease.