Four-dimensional flow magnetic resonance imaging demonstrates near normalization of aortic flow after the Ross procedure

The Ross procedure was first described in 1967. In it, the diseased aortic valve is replaced with a pulmonary autograft and the pulmonary valve is replaced with a homograft.1 Benefits of the Ross procedure include improved survival in patients younger than age 50 years, superior hemodynamics compared with manmade prostheses, and avoidance of lifetime anticoagulation therapy.2 This procedure is experiencing a resurgence largely due to the demonstration of a survival benefit. Contemporary series have shown operative mortality on par with aortic valve replacement; however, up to 15% of Ross patients still experience autograft failure and the mechanisms of failure are incompletely understood.