○ **Concomitant Left Sided Disease (Multi-valvular Endocarditis)**

Those with left sided involvement have worse outcomes in comparison with isolated TVE. These patients will require early surgical intervention to decrease mortality and improve outcomes. In a study by Musci and colleagues, 30-day survival was 96.2% for isolated right sided involvement in comparison to 72% for combined right and left-sided endocarditis [35].
