Successful Repair of a Bicuspid Pulmonary Autograft Valve Causing Early Insufficiency after a Ross Procedure

The Ross procedure is an excellent option in terms of long-term outcomes for young patients requiring aortic valve replacement. We report the case of a 49-year-old woman who presented with worsening dyspnea and episodes of presyncope in the context of a patient-prosthesis mismatch, 13 years after mechanical aortic valve replacement. She underwent a Ross procedure despite the pulmonary valve being bicuspid at intraoperative examination. Following implantation, the autograft valve showed an eccentric jet of regurgitation requiring bicuspid valve repair. To our knowledge, this is the first reported case of successful repair of a bicuspid pulmonary autograft valve.