Neonatal Ross Procedure for Infective Endocarditis in a Dysplastic Aortic Valve After Pulmonary Artery Banding

Background: Neonatal Ross procedure is rarely performed, especially in the setting of active infective endocarditis and prior pulmonary artery banding. Case summary: We present a rare case of a 2.5-month-old boy with a history of complex congenital heart disease, including aortic coarctation, severe aortic stenosis, and a ventricular septal defect, who developed infective endocarditis on a dysplastic bicuspid aortic valve. Discussion: This case highlights surgical decision-making and technical challenges in harvesting a pulmonary autograft after previous pulmonary artery banding in the presence of active infection. Take-home messages: Ross procedure can be feasible in neonates with complex anatomy and infection. Prior pulmonary artery banding increases technical complexity. Autograft resistance to reinfection supports its use in pediatric infective endocarditis.