The role of transesophageal echocardiography during the Ross procedure.

Pulmonary autograft replacement of the aortic valve, the “Ross procedure,” involves transplantation of the native pulmonary valve into the aortic position and reconstruction of the right ventricular outflow tract with a cryopreserved pulmonary or aortic homograft. In any surgeon’s hands this operation is technically challenging and successful performance of the Ross procedure requires strategies to avoid coronary artery and myocardial injury and optimize post-transplantation pulmonary autograft architecture. Transesophageal echocardiography (TEE) can be instrumental in guiding surgical management of these patients.