The environment of care has been shown to reduce the burden of disease and shorten healing time across multiple medical conditions. Given that many diseases respond to the unexplained regulation of the autonomic nervous system, the mechanism of interplay between the environment and this regulation needs to be explored and addressed as part of health care delivery. Complementary and alternative medical practices can be blended with traditional evidence-based medicine to optimally promote a healing environment and overall patient wellbeing. This review outlines the rationale behinded "blended medicine" and healing-oriented design of health care facilities, featuring examples and lessons learned from the North Hawaii Community Hospital.

The patient is a 75-year-old man with a history significant for hypertension and congestive heart failure who underwent a bioprosthetic aortic valve replacement secondary to acute onset of aortic insufficiency. Cultures of the native valve were positive for Staphylococcus epidermidis sensitive to nafcillin and intravenous cefazolin was initiated. On postoperative day 24, he developed acute decompensated heart failure. A transesophageal echocardiogram demonstrated a structurally abnormal mitral valve with severe regurgitation, anterior and posterior leaflet vegetations, and scallop prolapse. There was also evidence of a mitral-aortic intervalvular fibrosa pseudoaneurysm (P-MAIF) with systolic expansion and flow within the aneurysm. Antibiotic treatment was changed from cefazolin to vancomycin for presumed development of methicillin-resistant Staphylococcus. He subsequently underwent a bioprosthetic mitral valve replacement and has restoration of health without sequella. This case highlights the development of a P-MAIF as a rare complication of both aortic or mitral valve replacement and infective endocarditis.