Complete destruction of a tissue-engineered porcine xenograft in pulmonary valve position after the Ross procedure

a calcified tear in the noncoronary leaflet with perforation was observed. It is difficult to determine whether the tear was primary or calcium related. Probably, the presence of these calcium depositions encouraged tearing. We speculate that the postoperative finding of elevated peak transvalvular gradient was associated with a dynamic obstruction in the left ventricular outlet, and this situation led to mechanical stress during the systolic phase. The right coronary leaflet had intrinsic and vegetating calcifications with stiffness but without tearing. In addition, the commissural areas were severely calcified. These areas are designed to absorb and distribute the mechanical stress during the cardiac cycle. Thus when the leaflets are opened, they are completely free of stresses. Although a stent distortion is extremely rare and unusual, we can not reject this possibility completely.