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Modern challenges such as the liberalization of the railway sector and growing demands for sustainability, high-quality services, and user satisfaction set new standards in railway operations. In this context, railway infrastructure managers (RIMs) play a crucial role in ensuring innovative approaches that will strengthen the position of railways in the market by enhancing efficiency and competitiveness. Evaluating their performance is essential for assessing the achieved objectives, and it is conducted through a wide range of key performance indicators (KPIs), which encompass various dimensions of operations. Monitoring and analyzing KPIs are crucial for improving service quality, achieving sustainability, and establishing a foundation for research and development of new strategies in the railway sector. This paper provides a detailed overview and evaluation of KPIs for RIMs. This paper creates a framework for RIM evaluation using various scientific methods, from identifying KPIs to applying complex analysis methods. A novel hybrid model, which integrates the fuzzy Delphi method for aggregating expert opinions on the KPIs' importance, the extended fuzzy analytic hierarchy process (AHP) method for determining the relative weights of these KPIs, and the ADAM method for ranking RIMs, has been developed in this paper. This approach enables a detailed analysis and comparison of RIMs and their performances, providing the basis for informed decision-making and the development of new strategies within the railway sector. The analysis results provide insight into the current state of railway infrastructure and encourage further efforts to improve the railway sector by identifying key areas for enhancement. The main contributions of the research include a detailed overview of KPIs for RIMs and the development of a hybrid multi-criteria decision making (MCDM) model. The hybrid model represents a significant step in RIM performance analysis, providing a basis for future research in this area. The model is universal and, as such, represents a valuable contribution to MCDM theory. [ABSTRACT FROM AUTHOR]

Drone delivery in city logistics is gaining attention due to road congestion, environmental threats, etc. However, there are risks associated with using drones which can result in hazardous events, such as conflicts in the air, loss of control, and system failures. It is crucial to assess the risks involved in using different types of drones and choose the option with the lowest risk. The existence of different criteria important for this decision imposes the need to apply the multi-criteria decision-making (MCDM) method(s). This paper proposes a new hybrid model that combines the fuzzy Factor Relationship (FARE) method for obtaining the criteria weights and the Axial Distance-based Aggregated Measurement (ADAM) method for obtaining the final ranking of the alternatives. A single-rotor microdrone weighing up to 4.4 lb was chosen as the optimal solution, and after that, the most favorable are also the drones of this size (multi-rotor and fixed-wing microdrones). The establishment of a novel hybrid MCDM model, the identified risks, the set of criteria for evaluating the least risky drones, and the framework for prioritizing the drones are the main novelties and contributions of the paper. [ABSTRACT FROM AUTHOR]

Effective last-mile (LM) delivery is critical to the efficient functioning of supply chains. In addition to speed and the cost of delivery, environmental and social sustainability are increasingly important factors in last-mile logistics (LML), especially in urban areas. Sustainable solutions such as drones attract special attention from researchers due to their high potential. The future of drone logistics is uncertain due to many barriers. This study analyzes, evaluates and ranks barriers to identify those that most significantly hinder broader drone adoption in LML, and proposes and ranks strategies to overcome them. This type of issue requires the involvement of multiple stakeholders with conflicting goals and interests. Therefore, the study employs a novel hybrid multi-criteria decision-making (MCDM) model that combines fuzzy Delphi-based fuzzy factor relationship (Fuzzy D-FARE) and fuzzy comprehensive distance-based ranking (Fuzzy COBRA) methods. The results indicate that the main obstacle to drone implementation in LM is the lack of aviation regulations. The risks of unauthorized access, data misuse, privacy breaches, and data security represent significant challenges. They are followed by ambiguously defined or burdensome requirements for insurance and liability for drone owners. The main contributions of this study are the establishment of a novel hybrid model, identification and ranking of barriers for broader application of drones in LML, and strategies for overcoming them. [ABSTRACT FROM AUTHOR]

The purpose of this study is to conceptualize a novel idea of potentially sustainable city logistics concepts—the development of urban consolidation centers (UCCs) on riverbanks and the establishment of city-dry port (DP) micro-consolidation centers (MCCs) as their displaced subsystems within the delivery zone. The concept enables the application of river transportation in delivering goods to the UCC, where the modal shift to electric delivery vehicles takes place for delivering goods to city-DP MCCs. In the final delivery phase (from city-DP MCCs to flow generators), smaller eco-vehicles are utilized. An innovative methodology for the planning and selection of the most sustainable concept variant is developed. The methodology combines mathematical programming and the axial-distance-based aggregated measurement (ADAM) multi-criteria decision-making (MCDM) method. The application of the defined approach is demonstrated in a case study inspired by Belgrade, Serbia. The theoretical contribution of this study is in demonstrating how a wide set of potentially viable city logistics concepts can be defined, starting from an initial idea (city-DP MCC). The practical contribution lies in developing a robust methodology that considers all relevant tactical and operational-level planning questions and takes into account qualitative and quantitative criteria in evaluating different concept variants. [ABSTRACT FROM AUTHOR]

The development and advancement of human civilization have led it to its next great step - the exploration and colonization of outer space. Humans have had a continuous presence in outer space for more than twenty years, but until now, this was on the level of individual, isolated space missions. Reaching the cosmic level of civilization requires the planning and development of sustainable, long-lasting systems of space logistics. Previous scientific literature did not define the space logistics system adequately, nor did it identify the key elements and stakeholders/participants of such systems. The contribution of this article is in providing an encompassing definition of space logistics, the definition of space logistics system structure, and the role of different categories of logistics centres in its planning and development. The article provides a brief literature review in the domain of all types of human activities that take place in outer space and relates them with the realization of logistics processes to support those activities. Based on that, the main processes and functions that would take place in space logistics systems are defined, which dictate the emergence of diverse, specialized categories of space logistics centres. The identification and planning of appropriate space logistics cetres categories impacts the development directions and patterns of sustainable space logistics systems and enables the spatial integration of systems that cover enormous geographical dimensions and distances. [ABSTRACT FROM AUTHOR]

Procurement logistics stands out as one of the basic sectors in a logistics company. The other sectors in a company depend on procurement as it can cause downtime and delays that affect the entire company. In addition to the impact on the company itself, procurement can also have an impact on end-users, given that efficient procurement is one of the factors of competitiveness. One of the basic tasks of procurement logistics is the selection of suppliers. For this reason, the aim of this paper was to propose approaches based on AHP-QFD and ANP-QFD methodology in order to select suppliers. On that occasion, the evaluation of three suppliers was performed by applying eight criteria (price, product quality, on-time delivery, location, communication, reliability, flexibility, and reputation). The results of the application of the described methodologies also showed a different ranking of suppliers depending on the chosen methodology. [ABSTRACT FROM AUTHOR]

The number and spatial dispersion of households and their resources (means of transport, storage space, human resources, etc.), a large number of daily trips of various motives (shopping, work, school, tourism, waste disposal, etc.), makes households important participants in logistics chains. Moreover, these features make them potentially very important providers of logistics services of delivery, storage, waste collection, etc., both for other households and for companies. The use of logistics services, resources of households, i.e. individuals, known as crowd logistics, is experiencing rapid development with the advent of numerous networks and applications, through which users connect with each other and get the opportunity to state and accept requests for logistics tasks. In this paper, the role of households in the performance of logistics demands of other households and companies is analyzed and the basic crowd logistics services are structured, with special reference to the services in the last mile of the supply chain. Also, the basic benefits were identified, as well as the disadvantages, problems and challenges in the application of this concept. [ABSTRACT FROM AUTHOR]

Modern social trends are intensively transforming supply chains and the last mile as their most complex and most expensive segment. For the realization of the last mile, various solutions can be defined which combine initiatives, technologies, and concepts of city logistics. The successful implementation of these solutions depends on the characteristics of the city, the goals of stakeholders, and the ability to achieve economic, social, and environmental sustainability. In accordance with that, this paper defines innovative sustainable last mile solutions and evaluates their potential application in the real-life logistics system of the city. As evaluation requires consideration of a large number of criteria, this is a problem of multicriteria decision-making, and for solving it, a novel hybrid model that combines Delphi, FARE (Factor Relationship), and VIKOR (Višekriterijumska Optimizacija i Kompromisno Rešenje) methods in the fuzzy environment has been developed. The applicability of the model is demonstrated in the example of evaluating the last mile solution for the central business district of the City of Belgrade. A combination of microconsolidation centers and autonomous vehicles is obtained as the most favorable solution. [ABSTRACT FROM AUTHOR]

The development of intermodal transport (IT) systems is one of the global and European imperatives with the goal of mitigating logistics activities (especially transportation) negative impact on the environment, but also to improve the efficiency of logistics systems. Despite its importance acknowledged long ago, the treatment of IT greatly varies in different countries. In the developed countries, IT has an institutional character and clearly defined development directions, while in the developing countries, the problems of IT in most cases are ignored. The main scientific contribution of this paper is in being the first one to assess the status of IT in the countries of the Danube region. Seven criteria and six evaluation scenarios, that were not present in the existing literature in this form, are defined, which represents another contribution of the paper. The criteria are defined so that they would include the treatment of IT in strategic documents, the opinions of users and service providers, but also empirical/ statistical indicators of IT development degree. The evaluation scenarios differ in the criteria significance and the aspect of the problem. A novel hybrid multi-criteria decision-making (MCDM) model, based on fuzzy SWARA and fuzzy MARCOS methods, is developed for the assessment, which represents an additional scientific contribution of the paper. According to IT results, the countries are grouped into five categories, micro-regions. The results indicate that with the degree of economic development the status of IT improves as well, so Germany and Austria are leading, followed by the Czech Republic, then by countries such as Hungary, Slovenia and Slovakia, while other countries fall behind greatly. [ABSTRACT FROM AUTHOR]

Home delivery, as a flow of goods between the company and the consumer (B2C) at the end of the supply chain ("last mile"), can be realized by the manufacturer, retailer or third party (logistics provider, crowd-worker). The growth of home delivery services in recent decades has been predominantly stimulated by the development of online ordering, i.e. e-commerce. Delivery characteristics depend on the characteristics of the environment and a number of factors related to stakeholders (customers, companies, governments). In order to improve the quality of service and customer satisfaction, company profitability and (or) reduce the negative effects of deliveries on the environment, area and community functionality, various delivery models are designed and implemented in terms of need for ordering, frequency, ordering and payment system, starting and end points, executors, reception method, security, delivery area, speed and time of realization, return flows, etc. This paper proposes a framework for a comprehensive structuring and classification of home delivery models according to the stated characteristics/criteria. Also, the advantages, disadvantages, interdependence and applicability of different delivery models in changing circumstances are described. In this way, a comprehensive review of home delivery flows was performed, the literature that deals with this area in a similar way was supplemented, but the basis for future research was also created. [ABSTRACT FROM AUTHOR]

Due to the development of e-commerce and specific customer habits and requirements, in recent decades an increasing number of companies offer home delivery service, which is the flow of goods from the business to the consumer (B2C) at the end of the supply chain ("last mile"). The main characteristic and difference of home delivery in relation to other ways of supplying customers/households (traditional customer purchase, "click & collect" purchase, door-to-door sales) is the engagement of companies in picking/physical preparation and delivery of ordered goods to customers. Delivery characteristics depend on a number of factors and circumstances, preferences, goals and interests of stakeholders (customers, companies, governments), but there is also a strong interdependence, with the type of goods having a dominant influence on other delivery characteristics. Planning, organization and implementation of the process of ordering, picking, delivery and return of goods are a serious challenge for companies' logistics and information systems, generate high costs, increase freight transport and have a significant impact on the environment. Therefore, delivery characteristics are an important area of research and optimization of systems that implement this service. This paper analyzes the concept, basic characteristics and criteria for structuring home deliveries. In this way, the systematization of basic scientific knowledge about home delivery was performed and the basis for future research of various aspects of this field was created. [ABSTRACT FROM AUTHOR]

Tourism has been developing intensively in recent decades due to various social and economic trends. Rural tourism, which includes various tourist activities in rural areas (tourism in households, ecotourism, recreational, adventure, sports, health, artistic, heritage tourism, etc.) is also gaining in importance. The main instrument for the efficient realization of flows of people, goods and information in the Rural Tourism Supply Chain (RTSC) and increasing the competitiveness of tourism products is logistics. Logistics provides a material and a nonmaterial basis for rural tourism services. As suppliers of raw materials and finished products to other actors, but also as creators of their own tourism offer, households are significant actors in the supply chain and generators of logistics flows in rural tourism. A specific form of rural tourism related to households and agricultural production is called agritourism. This paper analyzes the critical issues and structure of the RTSC, structure the logistics of agritourism and analyzing particular areas in terms of logistics flows, processes, and activities. [ABSTRACT FROM AUTHOR]

Growing competition in the global market imposes the need for proper planning of logistics processes and development of logistics networks, where logistics centers (LCs) as nodes in these network play a key role. LCs can have different structures defined by various elements characteristics, and accordingly different efficiencies. In order to identify those that would represent benchmarks for other LCs it is necessary to define the broadest set of possible structures. However, in practice a number of structures is limited, which doesn't mean there might not be some which would be competitive or more efficient than the existing ones. Therefore the goal of this paper is the modeling of potential LC structures, based on the identified dependencies between the elements characteristics and the existing structures' efficiencies. The model is tested in a case study of modeling a potential intermodal terminal structure as one of the possible LC forms. [ABSTRACT FROM AUTHOR]

In order to meet the increasingly complex requirements in the fields of logistics and transport, intensive development and application of intermodal transport is necessary, whereby the planning and development of efficient intermodal terminals (IT) as one of the key intermodal transport sub-systems is crucial. Accordingly, this paper deals with the definition of types of inland IT combining different structural elements and the selection of efficient terminal types (TT). For solving this problem, a novel approach for defining the types of inland IT and a hybrid model for evaluating their efficiency are developed in this paper. The model combines the fuzzy EDAS (Evaluation Based on Distance from Average Solution) method of multi-criteria decision-making, used for defining the input weight limits based on the requirements of the stakeholders, and the AR DEA (Assurance Region Data Envelopment Analysis) non-parametric method, used for evaluating the efficiency of the types of inland IT. The applicability of the proposed model is demonstrated by solving the problem of selecting the efficient TTs in the group of "small" inland ITs, based on the analysis of real ITs in Europe. For the most efficient TT, the "small" inland road-rail hub terminal, mainly performing basic, supplementary and accompanying functions, is selected. The selected TT represent the benchmark for the other ITs that have the potential to develop into them and become the important elements in the development of the transport networks, regionalization of the ports and geographic expansion of their hinterlands, which are the key initiators of the regions' macro-economic development. [ABSTRACT FROM AUTHOR]

Intermodal Transport (IT) allows savings in energy, time and costs, improves the quality of services and supports sustainable development of the transport system. In order to make IT more competitive it is necessary to support the development of intermodal transport terminal (ITT), whereby it is very important to make adequate decision on its location. This paper proposes a framework for the selection of the ITT location which would be most appropriate for the various stakeholders (investors, users, administration and residents). They often have conflicting goals and interests, so it is necessary to define a large number of criteria for the evaluation. A novel hybrid MCDM model that combines fuzzy Delphi, fuzzy Delphi based fuzzy ANP (fuzzy DANP) and fuzzy Delphi based fuzzy Višekriterijumska Optimizacija i kompromisno Rešenje (fuzzy DVIKOR) methods is developed in this paper with the aim of providing support to decision makers. The model is developed in the fuzzy environment in order to overcome the ambiguity and uncertainty of the decision makers' evaluations of the criteria, sub-criteria and alternatives. The validity and applicability of the model is demonstrated by successfully resolving the problem of selecting the location of the ITT in the City of Belgrade. [ABSTRACT FROM AUTHOR]

City logistics aims to increase the efficiency and mitigate the negative effects of logistics processes and activities, and at the same time support the sustainable development of the urban areas. Major European and national research projects, undertaken from the end of the last century onwards, indicate that the state of the urban area logistics is quite critical. The situation requires a comprehensive analysis and active participation of the authorities and companies in order to solve the growing problems and define the sustainable solutions which would encourage the economic development and improve the living conditions in the city. In order to make logistics activities less routine, and thereby more efficient, many initiatives have been launched, especially in the terms of environmental impact and service quality. However, the changes are slow and environmental trends are setting new challenges. The main problem is the lack of planning activities and comprehensive and long term policy of city logistics. Decisions of city planners are often inadequate, without the analysis of existing situation and interaction of city logistics and complex socio-economic system of the city and its surrounding, without research and studies of different measures and impacts on the overall city logistics system. This article presented the current situation and trends in the implementation of logistics chains within the urban areas in order to highlight the complexity of solving the problems of a complex city logistics system. [ABSTRACT FROM AUTHOR]

Ranking of the logistics system scenarios of the Central Business District (CBD) of the city is performed in this article using the multi-criteria decision-making (MCDM) model which combined the methods of fuzzy "Analytical Hierarchy Process" (FAHP) and "Višekriterijumska Optimizacija i kompromisno Rešenje" (VIKOR). FAHP is applied for obtaining the weights of the criteria defined on the basis of conflicting goals of different stakeholders, and VIKOR method is applied for obtaining the final ranking of the logistics system scenarios. [ABSTRACT FROM AUTHOR]

City logistics (CL) tends to increase efficiency and mitigate the negative effects of logistics processes and activities and at the same time to support the sustainable development of urban areas. Accordingly, various measures and initiatives are applying and various conceptual solutions are defining. The effects vary depending on the characteristics of the city. This paper proposes a framework for the selection of the CL concept which would be most appropriate for different participants, stakeholders, and which would comply with attributes of the surroundings. CL participants have different, usually conflicting goals and interests, so it is necessary to define a large number of criteria for concepts evaluation. On the other hand, the importance of the criteria is dependent on the specific situation, i.e., a large number of factors describing the surroundings. In situations like this, selecting the best alternative is a complex multi-criteria decision-making (MCDM) problem consisting of conflicting and uncertain elements. A novel hybrid MCDM model that combines fuzzy Decision Making Trial and Evaluation Laboratory Model (DEMATEL), fuzzy Analytical Network Process (ANP) and fuzzy Višekriterijumska Optimizacija i kompromisno Rešenje (VIKOR) methods is developed in this paper. The model provides support to decision makers (planners, city administration, logistics service providers, users, etc.) when selecting the CL concept, which is successfully performed in this paper for the City of Belgrade. [ABSTRACT FROM AUTHOR]

Multicriteria decision making (MCDM) is a field that helps decision makers evaluate alternatives based on multiple criteria and encompasses scoring, distance-based, pairwise comparison, and outranking methods. Recent developments have aimed to solve specific problems and overcoming the limitations of previous methods. This paper proposes a new axial-distance-based aggregated measurement (ADAM) method, which is used in combination with the best-worst method (BWM) to evaluate agri-food circular economy (CE)-based business models (BMs) to create a more sustainable and efficient system for producing and consuming food. This paper proposes nine BMs, which were evaluated against eight criteria. The BWM method was used to obtain the criteria weights, while the ADAM method was used to obtain a final ranking of the BMs. The results indicate that a sustainable circular agri-food supply chain is a BM that can bring companies the most significant progress in business and strengthen their position in the market. We concluded that the ADAM method is effective for solving MCDM problems and that, overall, the model is an effective tool for solving the problem defined in this study. The main contributions are the development of a new MCDM method and a hybrid model, the establishment of the framework for evaluation and selection of CE-based BMs, and the identification of the most important ones. [ABSTRACT FROM AUTHOR]

Freight transport and logistics play a key role in economic and social terms by ensuring the competitiveness, economic growth and employment. Intermodal transport has received an increased attention due to problems of road congestion, environmental concerns and traffic safety. Strategic importance of speed, reliability and flexibility in the supply chain is forcing companies to re-examine traditional logistics services. As a result, interest in addressing the problem of intermodal transport and logistics is growing. In order to improve efficiency and sustainability of freight transport in Europe, the European Commission has launched a series of initiatives, projects and has defined the basic directions of development of intermodal transport and logistics. The paper presents the recommendations and measures for the further development of intermodal transport and logistics in Serbia. [ABSTRACT FROM AUTHOR]

The current business climate has generated considerable uncertainty and disrupted supply chain processes. Suppliers have frequently been identified as the primary source of hazards responsible for supply chain disruptions. Using a strategic approach to supplier selection that prioritizes providers with resilience features, mitigating the risk exposure inherent in supply chains is possible. This study proposes a comprehensive gray multiple-criteria decision making (MCDM) method incorporating resilience attributes to supplier selection. To determine criteria weights, the gray PSI and gray BWM methodologies were used, and to evaluate and prioritize resilient providers, the gray MCRAT and gray COBRA methodologies were applied. According to the results obtained by the suggested methodology, the supplier that demonstrated the greatest degree of resilience was determined to be the provider categorized as SPIR 4. The sequential sequence of the SPIR numbers is as follows: SPIR 5, SPIR 1, SPIR 3, SPIR 2, and SPIR 6. The data demonstrate that the developed approach produced accurate results. [ABSTRACT FROM AUTHOR]

Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient's further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p < 0.01) and higher rates of major complications, 33.7% vs. 16.8%, p < 0.01, and intrahospital 30-day mortality, 6.7% vs. 26.5%, p < 0.01. The strongest predictors of mortality were aortic regurgitation, HR 9.98, 95% CI 1.88; 52.98, p < 0.01, serum creatinine levels, HR 1.03, 95% CI 1.01; 1.04, p < 0.01, and respiratory failure therapy, HR 13.05, 95% CI 3.62; 47.01, p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Contrast echocardiography (CE) is an echocardiographic modality where ultrasound contrast echocardiographic agent (CEA) is introduced peripherally for the image enhancement. The aim of this study was to present the initial clinical experience of the use of CEA Optison™ (GE Healthcare, Princeton, NJ) at the Institute for Cardiovascular Diseases of Vojvodina, Serbia and prospectively monitor the occurrence of possible side effects. Methods. A total of 357 patients were referred for resting or stress echocardiographic examinations, with an approved indication for CEA administration. The average age of patients was 63.3 years (range, 21-92 years), 62% of them were men. Most of the patients (77.31%) had some form of ischemic heart diseases. Hypertension was the most frequent risk factor (77.03%), but 57 patients had diabetes mellitus and 33 patients had chronic kidney disease as comorbidity. Most (90.5%) of the patients were on beta blocker therapy, 83.5% of them on angiotensin converting enzyme/angiotensin receptor blockers. Majority (80.3%) of the patients received single or dual (49.5%) antiagregation therapy, 74 (26.3%), of them were on anticoagulation therapy, 55.1% of the patients were taking diuretics. The global ejection fraction (EF) was preserved in 39.85% of them, the majority (136 of them), had left ventricle (LV) impairment, with an EF less than 50%. Patients were followed up for 30 minutes after CEA administration for potential side effects. In 118 patients, vital signs (heart rate, oxygen saturation, body temperature, systolic and diastolic blood pressure) were measured before and 30 minutes after CEA administration. Results. The administration of CEA was not associated with side effects. Diastolic blood pressure drop and heart rate increase were statistically, but not clinically significant (p = 0.027 and p = 0.028, respectively). Conclusion. Changes in analyzed vital signs were clinically non relevant. CE is a safe noninvasive diagnostic modality for patients undergoing rest and stress echocardiography. [ABSTRACT FROM AUTHOR]

Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease (CHD) rarely detected in adults. Infective endocarditis represents a severe complication that carries a substantial risk. Case report. We here reported a case of a 43-year-old female with previously diagnosed adult CHD (partial AVSD and bicuspid aortic valve) presented to the hospital with fever and malaise 14 days prior to admission. On the lung computed tomography scan inflammatory consolidations were found and dual antibiotic therapy (ceftazidime and clarithromycin) was administered without significant regression of pulmonary inflammatory consolidations. The antibiotic treatment was continued with amoxicillin/clavulanic acid combined with levofloxacin and metronidazole. Transthoracic and transesophageal echocardiography revealed a large vegetation (dimension, 3.6 x 1.8 cm) attached to the septal leaflet of the tricuspid valve floating between right atrium and right ventricle through tricuspid valve with high embolic potential. Endocarditis team reached a decision for immediate surgical intervention. The operative findings revealed the partial AVSD, common atrioventricular valve with cleft of the anterior mitral leaflet in the A2 segment and detached and cleft septal leaflet of the tricuspid valve. Vegetation (size 4 x 3 cm) was attached to the septal side of the tricuspid annulus, basal segment of the anterior mitral leaflet and edge of the atrial septal defect freely floating between right atrium, right ventricle and left atrium. Excision of the vegetation and AVSD plastics were done, as well as the reconstruction of the mitral and tricuspid annuli and leaflets. The treatment was continued with antibiotics and completed in 18 days with full recovery. Conclusion. Early and precious diagnosis and optimal management that combines both conventional and surgical approaches are crucial for reducing the risk of complications and mortality in patients with infective endocarditis in grown-up congenital heart disease. [ABSTRACT FROM AUTHOR]