A 55-year-old man with native valve endocarditis caused by methicillin-sensitive Staphylococcus aureus has a 15 mm vegetation on the anterior mitral leaflet, severe mitral regurgitation, and NYHA class III heart failure. Blood cultures are positive. According to guidelines, when should surgery be performed?

• A After completion of 6 weeks of antibiotic therapy
• B Urgently during the first week of antibiotic therapy ✓
• C Only if recurrent embolic events occur
• D Electively after 2 weeks of antibiotic therapy

Explanation

Left-sided IE with heart failure due to valve dysfunction is a Class I indication for urgent surgery (within the first week of antibiotics), regardless of infection status. Delaying surgery in heart failure increases mortality. Large vegetations (>10 mm) with embolic phenomena also support early surgery, but heart failure alone is sufficient indication.

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

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Written and medically reviewed by the StethoPrep medical team.