Introduction
The proportional incidence of intravenous drug use (IVDU)-associated infective endocarditis (IE) cases requiring surgery has increased significantly, mirroring the national opioid crisis.1Relapse among patients with a history of IVDU is common and is the leading cause of death.2 Here we present treating a patient who relapsed post valve replacement presenting with severe TR and stenosis, right-sided heart failure, and ventral septal defect (VSD). As medical management failed, we offered the patient valvectomy and Extracorporeal Membrane Oxygenation (ECMO) as a potential bridge to definitive treatment with valve replacement.