The pulmonary valve must now be inspected to make sure it is suitable to use as a replacement for the aortic valve. The pulmonary artery is opened just below where it branches off. The pulmonary root is dismantled if the valve is suitable.

With the pulmonary artery detached from the pulmonary root, we are free to look down the shaft of the pulmonary root and inspect the leaflets. The leaflet being examined is thin and elastic, unlike the valve removed from the aortic root. One can virtually see through the leaflets of a normal pulmonary valve.

About 1% of the time, the pulmonary valve is not suitable for the Ross Procedure. If it has only two leafets (bicuspid) and should not be used as an autograft. Rarely, previous surgery such as VSD repair may have adverse effects on the valve and preclude transfer to to the aortic position. Leaflets may also be abnormal with intrinsic "floppiness" we term myxomatous disease or have extensive fenestrations in the leaflets which will interfere with proper function under higher pressure.