Endocarditis aórtica y pulmonar complicada con ictus hemorrágico: ¿cuál es el tiempo quirúrgico ideal?

A brain CT scan was performed on a 77 year-old old man who presented with sudden speech disturbances and behavioural changes, which showed bleeding in left frontal intraparenchymal area. He had a fever and positive blood cultures for Streptococcus bovis type i (gallolyticus). Transthoracic echocardiography was performed, which showed vegetations in aortic and pulmonary valves. Due to the context of haemorrhagic stroke, it was decided to wait at least 4 weeks, with antibiotic treatment, before performing surgery. During surgery, the pulmonary and aortic vegetations were excised, the aortic valve was replaced by a metal valve, with the pulmonary valve being conserved. The patient progressed favourably in the immediate and postoperative period. Antibiotic treatment was continued until confirmation of negative cultures of valves. No vegetations were obseved in the revision echocardiogram, and the patient was discharged to home a few days after surgery.