A 55-year-old woman with a prosthetic mechanical mitral valve develops fever and bacteremia. Transoesophageal echocardiogram shows a 12 mm vegetation on the atrial face of the prosthesis with new severe paravalvular regurgitation. The MOST important indication for urgent surgery in prosthetic valve endocarditis is:

• A Heart failure due to severe prosthetic valve dysfunction (paravalvular leak) ✓
• B Persistent fever after 3 days of antibiotics
• C Vegetation >10 mm with previous embolic event
• D Blood cultures positive for viridans streptococci

Explanation

Heart failure due to severe valve dysfunction is the strongest indication for urgent surgery in infective endocarditis per ESC guidelines (Class I indication). Severe paravalvular regurgitation causing haemodynamic compromise or pulmonary oedema mandates emergency surgery. Vegetation size >10 mm with prior embolism is also a surgical indication but of lower urgency than haemodynamic compromise. Viridans streptococcal IE generally responds well to antibiotics and rarely requires emergency surgery.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.