At the time of the patient’s first surgery in the seventies, balloon valvuloplasty was not yet available as a treatment option for PV stenosis. The first balloon valvuloplasty in humans was performed in 1982. Since then it has become the first choice of treatment in isolated valvular PV stenosis [3].

On the contrary pulmonary stenosis at different levels requires surgical treatment. Due to the necessity of early correction of congenital heart diseases, transannular patch plasty is more often performed in children. However, as described, it can be performed successfully even in adulthood, reducing heart load and improving quality of life. This technique can also be used in adults with infiltrative tumors of the right heart.

Even patients with corrected tetralogy of Fallot, in need of simultaneous reoperation on the aortic root and pulmonary valve are usually younger [4].

PV replacement with a homograft or biological valve is preferred due to a higher risk of thrombosis with mechanical valves on the PV position [5].

Follow-up studies have shown that while patients who have been treated for PV stenosis have a good outcome, 20% need a second intervention more than 20 years after the first one. Early treatment of patients with pulmonary stenosis has led to an increase in their life expectancy, it has also led to an increase in the number of patients who reach adulthood and need re-intervention [6]. Therefore, it is important to emphasize the need for regular check-ups to these patients, who consider themselves healed.

In our case, the patient did not have regular follow-ups after surgery and underwent a second intervention almost 50 years after the first one. A balloon valvuloplasty was not an option due to pulmonary stenosis at different levels as well as due to the coexistence of endocarditis of the aortic valve. Fetal endocarditis has been suggested as a possible etiology of pulmonary valve stenosis [2]. Studies show a possible genetic susceptibility to IE [7]. Moreau et al. showed a possible protective effect of SNPs on chromosome 3 against IE during Staph. aureus bacteremia [8]. Further studies on genetic susceptibility to endocarditis should be performed.