Double root re-replacement after Ross-Konno operation in a patient with straight back syndrome: clamshell approach

The most common indication for reoperation after Ross operation is degeneration of the pulmonic conduit. Pulmonary autograft (aortic root) dilatation and insufficiency is another potential problem during follow-up. This report describes double (aortic and pulmonary) root re-replacement 5 years after Ross-Konno operation in a patient with straight back syndrome. The causes of reoperation were pulmonary conduit degeneration, moderate aortic insufficiency, aortic root dilatation compressing left atrium, left main bronchus and left pulmonary artery. Clamshell technique provided safe and effective approach for this patient with very narrow thoracic cavity.