A 32-year-old man presented with shortness of breath, exertional fatigue, and chest pain. He underwent a Ross procedure in early childhood for rheumatic aortic valve disease, during which a 22 mm homograft was used in the right ventricular outflow tract. He subsequently underwent an unsuccessful attempt at transcatheter pulmonary valve implantation in his degenerated homograft.
During the evaluation, it was discovered that his proximal right coronary artery was occluded at the ostium. This was also associated with at least moderate aortic valve regurgitation and moderately depressed right ventricular function. A decision was made to proceed with reoperation.
Twin root replacement was performed with a 27 mm mechanical valve conduit in the left ventricular outflow tract, and a 27 mm pulmonary homograft was used for the right ventricular outflow tract. The right coronary artery was identified and bypassed with a reversed saphenous vein graft.
The postoperative course was uneventful, and he was discharged seven days later. He continued to do well during his follow-up.
References
- Stephens EH, Dearani JA, El Sherif N, Connolly HM, Bagameri G, Crestanello J, Pochettino A. Reoperations after the Ross procedure: Techniques, complexity, and outcomes. JTCVS Struct Endovasc. 2026 Jan 16;9:100098
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