Fourth Sternotomy with Reinforced Ross Procedure

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A twenty-year-old woman presented with a severe left ventricular outflow tract (LVOT) obstruction secondary to prosthetic aortic valve dysfunction. She was born with a bicuspid aortic valve and had undergone four previous operations: a left thoracotomy with left subclavian artery flap for repair of aortic coarctation and three sternotomies (resection of a subaortic membrane, resection of a recurrent subaortic membrane with open aortic valvuloplasty, and aortic valve replacement with a bioprosthesis) in addition to an ascending-to-descending bypass graft for recurrent aortic coarctation. She also underwent multiple balloon dilation and stent placement in her native aortic coarctation repair site. 

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