Early Aortic Autograft Infective Endocarditis with Perivalvular Abscess Following the Ross Procedure

Background: The Ross procedure provides excellent outcomes in young adults requiring aortic valve replacement, with lower rates of infective endocarditis (IE) compared to prosthetic valves. Early postoperative IE of the autograft is exceptionally rare, with only isolated cases reported in major registries. Case Summary: We report a 40-year-old man with bicuspid aortic valve and a history of two previous episodes of native valve endocarditis who underwent Ross procedure with Ozaki modification. Ten days postoperatively, he developed fever and was diagnosed with early autograft IE with perivalvular abscess formation. Despite negative blood cultures (due to prior antibiotic administration), clinical findings met modified Duke criteria for possible IE. Imaging revealed perivalvular abscess with subsequent pseudoaneurysm development, while the autograft leaflets remained functional. The patient was successfully treated with 6-week combination antibiotic therapy without requiring surgical reintervention. After one year of follow-up, he remains asymptomatic with stable pseudoaneurysm size and preserved valvular function. Conclusions: Early IE following Ross procedure, though rare, should be considered in patients presenting with postoperative fever. This case demonstrates that conservative management with appropriate antibiotic therapy can be successful even with perivalvular complications, provided there is hemodynamic stability and close multidisciplinary monitoring. Long-term surveillance remains essential given the persistent structural abnormalities.