The Ross Konno procedure is a technically demanding operation in neonates and infants, particularly in small babies and those with significant aortic annular and left ventricular outflow tract hypoplasia. There are several key technical considerations for harvesting the pulmonary autograft with care to preserve the left main coronary artery and the septal perforating arteries in addition to ensuring an optimal muscle cuff on the base of the autograft. Accommodation of the autograft deep within the native aortic valve annulus by performing an appropriate Konno incision and ensuring correct suture placement is essential. Adequate epicardial mobilisation and subsequent reimplantation of the coronary arteries into the autograft neo-aortic root is also a key consideration given the significant radial displacement of the coronary arteries required to accommodate the often much larger autograft into the space of a previously very small aortic root. Although the overall technical details of the Ross Konno procedure have previously been described by others the specific granular technical detail and meticulous approach required for a successful procedural outcome in neonates and infants remains to be fully elucidated. Key technical considerations such as suture spacing, positioning of the autograft with in the Konno incision and management of the coronary arteries require detailed description. We describe our institutional approach to the Ross Konno procedure in neonates and infants to clarify these important technical considerations.