Prosthetic Heart Valves Follow-up

  • Author: Eric M Kardon, MD, FACEP; Chief Editor: David FM Brown, MD   more...
 
Updated: Feb 8, 2010
 

Transfer

  • Initiate arrangements for transfer to a center with cardiac surgical capabilities in patients presenting with moderate-to-severe hemodynamic compromise if these services are not readily available.
  • The mortality rate in patients with acute prosthetic valvular failure is related directly to the delay of surgical correction.
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Deterrence/Prevention

  • Provide antibiotic prophylaxis to patients undergoing procedures that may result in bacteremia. This list, although not exhaustive, includes most inpatient and outpatient procedures performed in the ED that may result in bacteremia and, therefore, may lead to prosthetic valve endocarditis (PVE).[9]
    • Dental and oral procedures
    • Respiratory procedures, particularly those which involve disruption of the respiratory mucosal surface, or when a known infection is present
      • If a known infection caused by Staphylococcus aureus is present, prophylaxis with an antistaphylococcal penicillin, cephalosporin, or vancomycin should be given.
      • In cases of known or suspected methicillin-resistant Staphylococcus aureus, prophylaxis with vancomycin should be given.
    • Sclerotherapy of bleeding esophageal varices
    • Routine prophylaxis for gastrointestinal or genitourinary procedures is no longer recommended, unless in the presence of a known infection.
      • Urethral catheterization in the presence of a suspected urinary tract infection
      • Vaginal delivery in the presence of infection
    • Incision and drainage of infected tissues
  • For dental, oral, or upper respiratory tract procedures, use amoxicillin 2 g PO 30-60 minutes before the procedure.
    • If unable to take PO medication, use ampicillin 2 g IM/IV OR cefazolin 1 g IM/IV, OR ceftriaxone 1 g IM/IV 30-60 minutes before the procedure.
    • For penicillin-allergic patients, use clindamycin 600 mg PO/IM/IV OR azithromycin 500 mg PO OR clarithromycin 500 mg PO OR cephalexin 2 g PO 30-60 minutes before the procedure.
    • These are all single-dose regimens.
    • Do not use cephalexin in patients with a documented significant allergy to penicillin unless there is documentation that the patient can tolerate cephalosporins.
  • Further guidelines on the prevention, diagnosis, and treatment of infective endocarditis are available from the American Heart Association and the European Society of Cardiology.[9, 10]
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Complications

  • Glomerulonephritis, mycotic aneurysms, and metastatic abscesses may complicate PVE.
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Contributor Information and Disclosures
Author

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  2. Habib G, Thuny F, Avierinos JF. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis. Jan-Feb 2008;50(4):274-81. [Medline].

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  9. [Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Oct 9 2007;116(15):1736-54. [Medline].

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  11. Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician. Feb 2009;55(2):155-7. [Medline].

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Medtronic Hall mitral valve. Reproduced with permission from Medtronic, Inc.
The Hancock M.O. II aortic bioprosthesis (porcine). Reproduced with permission from Medtronic, Inc.
Starr-Edwards Silastic ball valve mitral Model 6120. Reproduced with permission from Baxter International, Inc.
Carpentier-Edwards Duralex mitral bioprosthesis (porcine). Reproduced with permission from Baxter International, Inc.
Carpentier-Edwards Perimount pericardial aortic bioprosthesis. Reproduced with permission from Baxter International, Inc.
St. Jude Medical mechanical heart valve. Photograph courtesy of St. Jude Medical, Inc. All rights reserved. St. Jude Medical is a registered trademark of St. Jude Medical, Inc.
 
 
 
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