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Herein, we present a case of aortic root replacement 42 years after aortic valve replacement AVR with the Björk-Shiley Spherical BSS valve in a patient with an aortic root aneurysm. The patient was a 67year-old man who had undergone AVR with BSS and aortic root enlargement for the treatment of infective endocarditis and aortic insufficiency at 25 years of age. He underwent aortic root replacement for an enlarged aortic root 73 mm . Under general anesthesia, median re-sternotomy was performed,doi:10.4326/jjcvs.50.170 fatcat:2c6w2x6finebnjgw4qli5rdx5q