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Native valve endocarditis — RCPSC IM MCQ

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HardInfectious DiseasesNative valve endocarditisRCPSC IM

A patient with Staphylococcus aureus bacteremia has a bicuspid aortic valve, a vegetation on transthoracic echocardiography and new PR-interval prolongation. What is the best next step?

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Correct answer: D — Obtain urgent transesophageal echocardiography and cardiac-surgical assessment for periannular extension

The best answer is “Obtain urgent transesophageal echocardiography and cardiac-surgical assessment for periannular extension”. New conduction delay in aortic-valve endocarditis suggests a periannular abscess. TEE better defines extension and prompts early surgical assessment; waiting can permit destructive complications. Periannular infection can progress to heart block, fistula or valve destruction, making early anatomic definition and operative input time-sensitive.

Reference: Infective endocarditis scientific statement, PubMed record: https://pubmed.ncbi.nlm.nih.gov/26373316/