Root reconstruction: key to neonatal truncal valve repair

Neonatal truncal valve insufficiency carries high postoperative mortality. Mechanical replacement is challenging, and leaflet-sparing repair alone may be insufficient due to fragile tissue and annular dilatation. We report a successful case using geometry-based root reconstruction guided by body-weight-adjusted reference values. This native-tissue approach restored physiologic root geometry, preserved the valve, and enabled growth potential, demonstrating a feasible strategy for durable neonatal repair.