Time	Patient 1
Five months prior	Uncomplicated bioprosthetic aortic valve replacement and coronary artery bypass graft (CABG)
Three months prior	Routine echocardiogram showed an appropriately functioning aortic valve but new tricuspid regurgitation
Initial event	Patient presents with fatigue, shortness of breath, and bilateral leg swelling.
Day 1	Echocardiogram reveals a left ventricle (LV) to right atrium (RA) shunt and partially dehisced aortic valve. Intravenous antibiotics commenced and surgery planned.
Day 9	Redo aortic valve replacement and fistula closure
Day 28	Discharged from hospital
Ten weeks after discharge	Feeling well at clinic review

Time	Patient 2
Five years prior	Bioprosthetic aortic valve replacement and CABG
Initial event	Admitted to hospital following a collapse. Clinically septic. Bedside echocardiogram revealed severe left ventricular systolic dysfunction (LVSD) but no evidence of infective endocarditis.
Day 1	Transferred to the intensive care unit (ICU) for inotropic support and haemofiltration. Klebsiella isolated from blood cultures.
Day 4	Formal echocardiogram again showed severe LVSD but no evidence of endocarditis.
Day 10	Weaned off inotropic support and stepped down to the general ward.
Day 18	Increasing inflammatory markers and persistent pyrexia. New occlusion of superior mesenteric artery and right lower lobe pneumonia on computerized tomography scan.
Day 25	New petechial rash. Repeat echocardiogram showed a partially dehisced aortic valve and LV to RA shunt.
Day 30	Further clinical deterioration and decision to move to palliative care. Died in the evening.