24th June 2026

You are a cardiology SHO in a large tertiary centre.

You are a cardiology SHO in a large tertiary centre. You have a patient on the ward who has a diagnosis of infective endocarditis. Blood cultures have isolated a candida spp in three separate samples, and the patient has been commenced on appropriate antimicrobial therapy. They have no murmur, no symptoms of heart failure, and are feeling fatigued but otherwise reasonably well since commencing treatment. Their admission ECG shows a new atrial fibrillation at a rate of 86 bpm. Echocardiogram has identified an isolated 6mm vegetation on the aortic valve, associated with mild aortic regurgitation. The left ventricular ejection fraction is 55% and the right ventricular function is normal. 

What is the indication for surgery in this patient? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.