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Infective Endocarditis — EECC MCQ

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HardValvular Heart DiseaseInfective EndocarditisEECC

A 62-year-old man presents with fever (39.2 degrees C), weight loss, and a new murmur. Blood cultures grow Staphylococcus aureus (2/2 sets). Transoesophageal echocardiography shows a 15 mm vegetation on the aortic valve with moderate aortic regurgitation and a small paravalvular abscess. He has no embolic events. His antibiotics have been started. Per the 2023 ESC IE Guidelines, what is the most appropriate timing for surgical intervention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Emergency surgery (within 24 hours)

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

Per the 2023 ESC IE Guidelines, a paravalvular abscess in aortic valve endocarditis due to S. aureus represents locally uncontrolled infection. Emergency surgery (within 24 hours) is indicated for locally uncontrolled infection (abscess, fistula, enlarging vegetation). Waiting for completion of antibiotics (C, E) risks further destruction. Urgent surgery (B) may be considered for persistent infection after 72h on antibiotics, but a paravalvular abscess merits emergency timing.

Reference: ESC (2023): Guidelines for the Management of Infective Endocarditis