A case report supporting early surgery in mitral valve infective endocarditis with recurrent cerebral infarcts.

Background: In patients with infective endocarditis, brain embolism portends a poor prognosis. The timing of surgery in patients who require emergency valve surgery in the setting of deteriorating level of consciousness from recurrent embolic events, and brain infarction with haemorrhagic transformation, remains controversial.

Case summary: We report a case of a 54-year-old male who presented with Streptococcus salivarius mitral valve endocarditis, recurrent episodes of cerebral embolic infarctions with haemorrhagic transformation and deteriorating level of consciousness, and successfully underwent emergency mitral valve surgery without extension of the preoperative cerebral embolic complication or worsening of neurological symptoms.

Discussion: Mitral valve surgery can be performed successfully in patients with mitral valve endocarditis and cerebral embolism earlier than the recommended 2-4 weeks, and this should be considered in deteriorating patients.