A 23-year-old female at 34 weeks gestation with a history of IV heroin use presents with fever and a new heart murmur. This patient will likely require which surgical intervention?

• A. Cardiac valve replacement
• B. Decompression of hand compartment syndrome
• C. Infected pericardial sac
• D. Pulmonary artery debridement

Answer: (A)

Infective endocarditis from IV drug use can destroy heart valves, leading to severe regurgitation or heart failure that cannot be controlled medically. When a valve is extensively damaged by infection, removing the infected tissue and replacing the valve is often necessary to restore cardiac function and prevent further complications. In this scenario, a patient with fever and a new heart murmur at 34 weeks gestation is highly suspicious for IE, and the extent of valvular destruction would make valve replacement the most likely surgical need.

The other options don’t fit this presentation. Decompression of a hand compartment syndrome would be related to limb ischemia from injection, not to a new murmur. An infected pericardial sac suggests purulent pericarditis, which presents differently than a new valvular murmur. Debridement of the pulmonary artery is not a standard intervention for infective endocarditis.