In a pregnant patient with IV drug use presenting with fever and murmur, which surgical intervention is most likely indicated?

• A. Cardiac valve replacement
• B. Infected pericardial sac drainage
• C. Hand compartment decompression
• D. Pulmonary artery debridement

Answer: (A)

Infective endocarditis from IV drug use commonly attacks a heart valve, and fever with a new or changing murmur points to valve involvement with destruction and potential hemodynamic compromise. When the infection has progressed to the point of significant valvular damage, causing severe regurgitation or heart failure, or when the infection persists despite antibiotics, surgical replacement of the affected valve becomes the definitive treatment. In a pregnant patient, controlling the infection and preserving maternal cardiac function is critical for both mother and fetus, so replacing the diseased valve is the intervention most likely indicated to restore proper valve function and hemodynamics.

The other options don’t fit this scenario. Draining the infected pericardial sac targets purulent pericarditis rather than valvular endocarditis. Decompressing a limb compartment is for compartment syndrome, not a cardiac infection. Debridement of the pulmonary artery is not a standard primary treatment for infective endocarditis and would not address the valve destruction driving the clinical picture.