According to the 2023 ESC Endocarditis Guidelines, which of the following is an absolute indication for urgent surgical intervention in infective endocarditis?
- A Vegetation >10 mm on echocardiography in the absence of embolic events
- B Heart failure due to severe aortic regurgitation from leaflet perforation ✓
- C Persistent bacteraemia after 5 days of appropriate antibiotics
- D Positive blood cultures without echocardiographic vegetation
Explanation
Acute heart failure due to valve destruction (leaflet perforation, rupture of chordae) causing severe haemodynamic compromise is a Class I indication for emergency surgical intervention in IE, as mortality without surgery approaches 80% in this setting. The 2023 ESC guidelines emphasise urgent surgery (within 24 hours) for refractory heart failure from valvular incompetence. Vegetation > 10 mm without embolism is a relative indication for surgery to prevent embolic events. Persistent bacteraemia after 5–7 days warrants investigation for abscess or metastatic infection, and may lead to surgical decision.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.