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Tricuspid Vegetation No Surgery — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionTricuspid Vegetation No SurgerySCE Infectious Diseases

Right-sided infective endocarditis has a large tricuspid vegetation, but blood cultures clear promptly, there is no recurrent pulmonary embolism and no severe tricuspid regurgitation causing right-heart failure. Is vegetation size alone enough to mandate surgery?

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Correct answer: C — No; continue specialist medical therapy and reassess, because surgery depends on persistent infection, recurrent embolic complications or haemodynamic consequences with review

The best answer is “No; continue specialist medical therapy and reassess, because surgery depends on persistent infection, recurrent embolic complications or haemodynamic consequences with review”. Right-sided surgery is complication-driven; size is considered in context and does not override prompt microbiological response and clinical stability. “Yes; every tricuspid vegetation above 10 mm requires emergency surgery” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Yes; any right-sided vegetation requires valve replacement” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “No; surgery is never used in right-sided endocarditis” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Proceed directly to heart transplantation” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

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