Candida endocarditis involving the pulmonary valve and main pulmonary artery after pulmonary artery banding: two infant cases

Pulmonary valve or main pulmonary artery infective endocarditis is rare in children and is associated with high morbidity and mortality. Fungal infective endocarditis, most commonly caused by Candida species, is particularly aggressive and often requires a combination of antifungal therapy and surgical intervention. We report two infants who developed Candida endocarditis following pulmonary artery banding.In the first case, a female infant developed persistent candidemia after pulmonary artery banding, with echocardiography revealing a mobile mass at the pulmonary bifurcation and computed tomography angiography demonstrating a mycotic pseudoaneurysm. Blood cultures confirmed Candida albicans. She underwent debanding and main pulmonary artery reconstruction, later requiring pacemaker implantation, and recovered without relapse. In the second case, a female infant presented with fever and candidaemia after pulmonary artery banding. Echocardiography identified a distal main pulmonary artery vegetation, and cultures grew Candida parapsilosis. She received amphotericin B-based induction therapy followed by fluconazole step-down after surgical source control, achieving clinical cure at follow-up.These cases highlight the diagnostic and therapeutic challenges of Candida endocarditis after right-sided palliation. Early multimodality imaging, species-directed antifungal therapy, and timely surgery are critical to optimise outcomes in this rare but life-threatening complication.