This male patient in his early 60s presented with 3 months of worsening fatigue, anorexia, breathlessness and more recently, fevers. He was also investigated for new back pain and found to have vertebral discitis. Blood cultures were positive for enterococcus faecalis. Echocardiogram confirmed moderate to severe aortic and mitral regurgitation with multiple small sub-centimetre vegetations on the leaflets of both valves. The diagnosis of subacute bacterial endocarditis involving the aortic and mitral valves was made and he was started on intravenous antibiotics. After 7 days of treatment his blood cultures remained positive though he reported symptomatic improvement.

At surgery the diagnosis of infective endocarditis was confirmed with multiple small vegetations seen on both valves. There was two small perforations in the right and left leaflets of the aortic valve. No deep tissue involvement was observed. We implanted two ONX mechanical valve prostheses. He made an uneventful recovery and was discharged home after a week.

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