1. Heart failure, perivalvular infection, and high embolic risk are the 3 main indications for early surgery.
2. Echocardiography plays a major role in decision-making when one of these situations occurs.
3. Echocardiography helps clinicians not only for taking the decision to operate or not, but also for choosing the optimal timing of surgery.
4. The presence of heart failure, abscess, or high embolic risk usually indicates urgent surgery.