We present a case of progressive pulmonary autograft root dilatation and su
bsequent failure after a Ross procedure. The explanted autograft vessel wal
l revealed striking histologic findings indicative of chronic media rupture
. Examination of another explanted pulmonary autograft root showed similar
histologic changes, suggesting a common phenomenon in pulmonary autograft r
oots. It may be the cause of progressive root dilatation as observed after
Ross operations. (C) 1999 by The Society of Thoracic Surgeons.