A 26-year-old woman presented with a 2-month history of fever, rashes on both legs, shortness of breath for the past 10 days, swelling of both legs and abdomen and face for 7 days, weakness and weight loss. On examination, she was ill-appearing and breathless with a rapid pulse, low blood pressure, elevated jugular venous pressure, murmur at the pulmonary area, and crackles in both lungs. Tests showed vegetation on the pulmonary valve, pulmonary regurgitation, enlarged right ventricle and atrium, and pulmonary hypertension. She was diagnosed with infective endocarditis of the pulmonary valve with pulmonary regurgitation and heart failure, and was started on intravenous antibiotics and