The Correct Answer is B!

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A 66-year-old man presents with failure to thrive after aortic valve replacement (AVR) four years ago. Over the last two years, he has experienced weight loss, low-grade fevers, and two transient ischemic attacks. He had a bronchoscopy to investigate pulmonary infiltrates and this resulted in the diagnosis of suspected sarcoidosis. He was treated with steroids but had further deterioration in his clinical status and is now frail and ill, and wheelchair-bound.

Your investigation shows:


  • Severe stenosis of the bioprosthetic aortic valve
  • Large echodensities on the valve
  • All blood cultures at 72 hours – no growth


What would you do next?

  1. Send for surgical AVR immediately
  2. Bone marrow biopsy and culture
  3. Triple antibiotics for 1 week and then surgical AVR
  4. Send for valve-in-valve procedure