NHS AAA Screening Programme — EECC MCQ

Correct answer: A — Urgent valve surgery plus prolonged targeted antifungal treatment

The best answer is “Urgent valve surgery plus prolonged targeted antifungal treatment”. Fungal prosthetic-valve endocarditis has high embolic and relapse risk; source control usually requires surgery combined with prolonged antifungal therapy. “Complete antifungal therapy and avoid surgery in every fungal infection” is less appropriate because medical therapy alone has a high failure and recurrence rate in this destructive setting “Switch to oral fluconazole monotherapy and discharge” is less appropriate because oral step-down without source control is inadequate with persistent candidaemia and emboli “Use thrombolysis to dissolve the vegetation” is less appropriate because thrombolysis risks intracranial and systemic bleeding without sterilising infection “Implant a transcatheter valve inside the infected prosthesis” is less appropriate because valve-in-valve implantation leaves infected material in place and adds prosthetic substrate

Reference: 2023 ESC Guidelines for infective endocarditis. https://academic.oup.com/eurheartj/article/44/39/3948/7243107