Redo quadruple-valve repair after Ross procedure: a viable option?

Quadruple-valve repair or replacement is associated with significant morbidity and mortality because the clinical situation of severe disease of all 4 valves implies incipient myocardial damage. We report a case of redo quadruple-valve repair in a patient with rheumatic heart disease who had undergone the Ross procedure 14 years earlier. He presented with heart failure. Cardiac evaluation revealed severe disease of all 4 valves, necessitating surgery. Because he was in advanced heart failure and all 4 valves were suitable for repair, a quadruple-valve repair was performed.