The use of pulmonary autograft for aortic valve replacement (Ross procedure) offers an excellent option for the younger patient with its potential for growth and long term viability. We report our experiences of 61 patients with a mean age of 17.0 years undergoing Ross procedure over a four year period. Rheumatic disease was the cause of aortic valve disease in 48 (79.0%) patients. Mitral valve surgery was required in 18 (29.5%) patients. There was no hospital death, endocarditis or thromboembolism in the series. There was one late death from non-cardiac cause and three (4.9%) reoperations. Two of the reoperations were for progressive autograft regurgitation whilst the third was for mitral valve repair failure. Echocardiographic profiles of 37 of these patients followed beyond six months after surgery show a tendency towards progression of the autograft regurgitation. The long term effects of rheumatic disease on the transplanted valves remain to be evaluated.