Large Pulmonary Valve Vegetation Causing Right Ventricular Outflow Tract Obstruction in an Infant: Successful Complete Excision and Valve-Preserving Surgical Management

Isolated pulmonary valve infective endocarditis is exceedingly rare in infancy. We report an 8-month-old male infant presenting with feeding diaphoresis, failure to thrive, and intermittent fever for 3 months. Echocardiography demonstrated a large mobile mass (12 × 18 mm) attached to the pulmonary valve causing severe right ventricular outflow tract obstruction with a peak gradient of 56 mmHg. Computed tomography thoracic angiography also confirmed the presence of a 16 × 11.5 mm hypodense lesion at the level of the pulmonary valve causing pulmonary arterial obstruction. Urgent surgical intervention was performed. The mass was excised completely along with the pulmonary leaflet, and pulmonary valve neocuspidization was performed using glutaraldehyde-treated autologous pericardium. Histopathology confirmed infective vegetation. The postoperative course was uneventful, and follow-up echocardiography showed no residual obstruction with trivial pulmonary regurgitation. This case highlights the importance of early diagnosis and demonstrates that valve-preserving reconstruction using autologous pericardium is a feasible and effective strategy in infants with destructive pulmonary valve endocarditis.