Table 4. Echocardiographic features suggesting surgical intervention.

ECHOCARDIOGRAPHIC FEATURES SUGGESTING SURGICAL INTERVENTION
Vegetation	Persistent vegetation after systemic embolization.: Anterior mitral leaflet vegetation with size >10mm,  ≥1 embolic event during the first two weeks of antimicrobial therapy, or ≥ two embolic events during or after antimicrobial treatment.
	Increase in vegetation size after four weeks of antimicrobial therapy
Valvular dysfunction	Mitral valve insufficiency with signs of ventricular failure or aortic valve insufficiency
	Heart failure in patients who are unresponsive to medical therapy.
	Ruptured or perforated wall
Perivalvular extension	Valvular dehiscence, rupture, or fistula
	New heart block
	Abscess or its extension despite appropriate antimicrobial therapy.