David operation for insufficient pulmonary autograft after Ross-Konno procedure

We report the case of a 25-year-old female who developed severe aortic regurgitation because of pulmonary autograft root dilatation late after Ross-Konno procedure. The geometric heights of all three cusps were relatively small, allowing for the David operation with a 24-mm straight graft. We carefully dissected the aortic root and, the dissection process was relatively straightforward, and the basal ring could be sutured properly. The latest follow-up TTE showed normal autograft valve function and mild aortic regurgitation. Even in the Ross-Konno procedure, valve-sparing root replacement is possible, as in the Ross procedure.