The medication treatment case of late infective endocarditis, complicated by cerebrum vegetation, is presented. Surgery is the only solution at aortic valve prosthetic endocarditis, but only in cases, when there is no concurrent serious neurologic deficit of cerebrum structures, which makes it impossible to use artificial blood flow. Adequately chosen long term antibacterial therapy in combination with fungicide therapy provides reasonable positive results. Concurrent significant brain vegetations make the recovery more complicated, but the infection process on the aortic prosthesis is stopped, which is proved by instrumental diagnosis. The Institute experience shows a correct clinical approach for a solution of a very complicated and rare clinical case. Early diagnosis of pathogen (including preventive echocardiography after any body temperature increase, which lasts for several days) and immediate dedicated professional help are very important. Introduction. Prosthetic endocarditis is a problematic complication in a long term. Vegetation as thromboembolic complication leads to different levels of neurologic deficit. Case description. Patient F., female, 35 y.o., was hospitalized to the Department of Surgery of Acquired Heart Diseases of the Amosov National Institute of Cardiovascular Surgery with diagnosis of congenital heart disease on September 05, 2016. Bicuspid valve, aortic stenosis of degree 4 with calcinosis 3+, mitralization, poststenotic distensibility of ascending aorta, type IIA heart insufficiency. The surgery was performed on September 07, 2016: aortic valve replacement with wrapping tape operation II. The patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition. Patient F. was hospitalized again to the Institute with the diagnosis of late aortic valve prosthetic infective endocarditis on November 20, 2019. The condition was after aortic valve replacement and wrapping tape surgery in 2016, A-V block of degree 1, cerebral infarctions in multiple locations with hemorrhagic transformation, with aphasia elements, ataxia, right side pyramidal insufficiency and suspected meningitis. After prolong medication, the patient responded to treatment successfully and was discharged from the hospital in a satisfactory condition without surgical treatment. Conclusions. Taking into consideration the serious condition of the patient, timely and correct medication can be the correct solution for treatment of patients with late infective endocarditis. Thus, surgery is not always the treatment choice.

Keywords: secondary infective endocarditis, medication treatment, cerebral infarction.