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Background: Dilatation of the pulmonary autograft is a major drawback of the Ross procedure and it is the leading cause for reoperation in these patients.

Case Presentation: In this report we describe 3 cases reports, each one with a different outcome, of patients that underwent the Ross procedure.

Conclusions: In order to prevent any lethal or non-lethal complications of the pulmonary autograft these patients need a close and life- long systematic follow-up.

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