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Intracardiac vegetations in neonates are relatively rare and are usually diagnosed on discovery of related symptoms such as persistent thrombocytopenia, a new onset murmur or persistent sepsis.1,2 We present the case of a female twin 25+2 week preterm neonate with a birth weight of 840 g, and bilateral grade IV intraventricular haemorrhages. An intracardiac vegetation was diagnosed incidentally on day 17 of life after routine monitoring of a patent ductus arteriosus unresponsive to medical treatment. Echocardiography revealed a vegetative mass extending to both atria with its centre attached to the atrial septum at the level of the foramen ovale. This vegetation carries a high risk of embolisation to the brain because of its unique position. On the previous day a peripherally inserted central catheter was placed and noted to touch the interatrial septum. Blood cultures grew Staphylococcus warneri which was sensitive to vancomycin and she began a 6-week course, with good response.