Abstract
INTRODUCTION: Congenital heart defects predispose patients to a significantly increased risk of infective endocarditis (IE), and the incidence is even greater in the immunocompromised population. The involvement of multiple valves leads to a higher rate of complications and thus mortality. Moreover, biventricular IE is an uncommon condition with no specific guidelines for treatment. CASE PRESENTATION: In this report, we discuss a case of an immunocompetent young male with a congenital perimembranous ventricular septal defect, complicated by multivalvular and right ventricular free wall vegetations. Biventricular involvement of IE along with septic embolization to both the pulmonary and systemic circulation resulted in challenges in the management of this patient. DISCUSSION: The decision regarding timing and type (surgical vs. conservative) of treatment in such a complicated and aggressive IE case should be based on individual circumstances. However, the strategy of initial antibiotic therapy followed by surgical intervention can be a suitable option in such patients.