Features Suggesting Potential Need for Surgical Intervention

Features Suggesting Potential Need for Surgical Intervention

Valvular dysfunction

Heart failure unresponsive to medical therapy

Acute aortic or mitral insufficiency with signs of ventricular failure

Vegetation Characteristics

Persistent vegetation after systemic embolization

Anterior mitral leaflet vegetation, particularly with size > 10mm

Severe valve regurgitation and mobile vegetations >10mm

One or more embolic events during first two weeks of antimicrobial therapy

Increase in vegetation size despite appropriate antimicrobial therapy

Valve Perforation or Rupture

New heart block

Perivalvular extension, annular or aortic abscess, destructive penetrating lesions

Valvular dehiscence, rupture or fistula

Large abscess or extension of abscess despite appropriate antimicrobial therapy

Microbiology Characteristics

Fungi or highly resistant organisms (VRE, multi-drug resistant Gram-negative bacilli)

Persistent bacteremia or fever lasting more than 5-7 days after starting appropriate antimicrobial therapy