Indication for surgery in patient with associated condition
| Indication for surgery | Timing |
|---|---|
| Heart failure | |
| Aortic/mitral IE with severe regurgitation/valve obstruction causing pulmonary oedema or cardiogenic shock | Emergency |
| Aortic/mitral IE with fistula into cardiac chamber or pericardium causing refractory pulmonary oedema or shock | Emergency |
| Aortic/mitral IE with severe acute regurgitation or valve obstruction and persisting heart failure or echocardiographic signs of poor hemodynamic tolerance | Urgent |
| Aortic /mitral IE with severe regurgitation and no HF | Elective |
| Uncontrolled Infection | |
| Locally uncontrolled infection (abscess/aneurysm/fistula/enlarging vegetation) | Urgent |
| Persisting fever and positive blood culture >7-10 days | Urgent |
| Infection caused by fungi or multiresistant organism | Urgent |
| Prevention of Embolism | |
| Aortic/mitral IE with large vegetation(>10mm) following episode of embolism despite appropriate antibiotic therapy | Urgent |
| Aortic/mitral IE with large vegetation(>10mm) and predictor of a complicated course | Urgent |
| Isolated very large vegetation(>15mm) | Urgent |