The enigma of timing for cardiac surgery in aortic valve infective endocarditis with cerebrovascular complications: a case report.
Mihail Celeski, Lorenzo Scalia, Laura Gatto et al.
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Case in brief
An 80-year-old woman developed embolic ischemic stroke in the setting of native aortic valve infective endocarditis. The stroke complicated decisions about the timing of cardiac surgery, prompting multidisciplinary management and consideration of the competing risks of operating early versus delaying intervention. The report describes the case as highlighting the potential neurologic risks of early surgery alongside the hazards of delay, including valve destruction, heart block, further embolism, and death. The abstract does not specify the eventual surgical timing or clinical outcome.
What made this case unusual
The central challenge was balancing cardiac surgical urgency against the risk of neurologic worsening after an embolic ischemic stroke, despite very high surgical risk.
Diagnostic / clinical pearl
In aortic valve infective endocarditis complicated by ischemic stroke, surgical timing requires multidisciplinary assessment of neurologic risk alongside the potential harms of delaying intervention.
Why it matters
The case illustrates unresolved questions about surgical timing in this setting and the need for further research.