A 40-year-old man with infective endocarditis of the aortic valve develops sudden right-sided hemiplegia. CT shows an embolic ischemic stroke without hemorrhage. He has severe aortic regurgitation and NYHA class II symptoms. When is the optimal timing for valve surgery?
- A Immediate surgery within 24 hours
- B Surgery after 6 weeks of antibiotic therapy
- C Surgery after 2-3 weeks of antibiotic therapy ✓
- D Surgery only if heart failure worsens
Correct answer: C. Surgery after 2-3 weeks of antibiotic therapy
Explanation
After an embolic ischemic stroke without hemorrhage, valve surgery should be delayed for 2-3 weeks if possible to reduce the risk of hemorrhagic transformation during cardiopulmonary bypass. However, if there is severe valve regurgitation with refractory heart failure or uncontrolled infection, urgent surgery may be necessary despite the stroke. This patient has NYHA II symptoms, so a brief delay is reasonable.
Reference: Braunwald's Heart Disease, 12th ed.
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