Role of Transesophageal Echocardiography in the Diagnosis of Coronary Ischemia in a Patient with History of Ross Procedure

• Multidisciplinary management is essential for complications post–Ross procedure. • Symptomatic coronary ischemia may occur late in Ross procedure patients. • Coronary ostium narrowing is a differential for ischemia post–Ross procedure. • TEE can aid in diagnosing coronary stenosis in a Ross procedure patient. • TTE may miss eccentric AR post–Ross surgery; high suspicion justifies TEE.