One of the contraindications for a stentless aortic valve is dilation of the aorta such that the sinotubular ridge is more than 2 mm larger than the annulus. Since May of 1994, 134 patients have had their aortic valve replaced with St Jude Toronto SPV valves; of these, 38 patients have required sinotubular ridge reduction. This was done by using one or more pleats in the aorta between the commisural posts. There were 20 patients with one pleat, 12 patients with two pleats, 5 patients with three pleats, and 1 patient with four pleats. In addition, three Toronto SPV valves were used in patients with significant calcification in the native coronary sinuses. All of the valves have had trace or no aortic insufficiency and have not developed aortic insufficiency in follow-up evaluation. Mean gradients remain low (<10 mm Hg). These valves have been much more versatile than originally expected and can be used in patients with mild to moderate aortic dilation and calcification.