BACKGROUND: Despite advances in management, infective endocarditis remains a condition with high in-hospital and post-discharge mortality, especially when it is complicated by perivalvular extension and heart failure (HF).

CASE REPORT: Herein we describe two illustrative cases of endocarditis. The first case was complicated by left ventricle to right atrial fistula. The second cased was complicated by valvular perforation with a “windsock” appearance. Both patients developed acute HF.

CONCLUSIONS: Fistulas and severe valvular regurgitation are among the major causes of acute HF in the setting of infective endocarditis. In such cases, surgery should be considered to decrease mortality.

Keywords: Endocarditis, Staphylococcus aureus, Aftercare, Endocarditis, Bacterial, Heart Valve Diseases, Patient Discharge