Prevention of Bacterial Endocarditis

1
Prevention of Bacterial Endocarditis

• Peter S Rahko MD
• Cardiovascular Medicine

2
Endocarditis Causes

• Underlying structural heart disease
• Introduction of common pathogens for endocarditis
  into the blood
• Complications of focal infections
• Complications of procedures

3
Aortic and Mitral Endocarditis
AV
MV
4
TEE of MV Endocarditis Maximal Vegetation
Dimensions
Dimensions
LA
5
Endocarditis Pathophysiology
Diseased Valve with disrupted endothelial surface
Sterile fibrin platelet thrombus forms on valve
Valve infected
Embolic Events
Local tissue destruction
Immune Complexes
Valve regurgitation Abscess Pericarditis, Fistula
formation
Cerebral, systemic, pulmonary
Arthritis, nephritis
6
Typical Endocarditis Organisms

• Strep viridans
• Strep bovis
• Strep faecalis
• Other strep
• Staph coagulase and
• Gram negative, fungal and culture negative

7
Endocarditis

• No randomized controlled trials in humans with
  underlying structural heart disease that
  definitively establishes SBE prophylaxis as
  beneficial.
• Animal models
• Retrospective analysis

8
Endocarditis Considerations

• Incidence after procedures is low
• Type of structural heart disease
• Risk of bacteremia
• Adverse reactions from antibiotics

9

• 3x5 Cards
• What went well
• What needs work
• Questions that remain

10
Common factors for high and moderate risk lesions

• Artificial material
• High pressure lesions
• Turbulent blood flow lesions
• Rough irregular surface with endothelial
  disruption

11

• 3x5 Cards
• What went well
• What needs work
• Questions that remain

12
Low risk lesions Common factors

• Mild disease or previously repaired disease no
  longer associated with turbulent flow.
• Low pressure lesions
• Mild structural disease without a murmur or high
  pressure flow jet

13
Mitral Valve Prolapse

• Wide spectrum of disease
• Prolapse of an otherwise normal valve is
  possible, usually there will be no MR with this
  and no auscultatory findings No SBE P
• Patients with MVP and MR by Doppler or
  auscultation Yes SBE P
• Patients with myxomatous degeneration of the MV
  and MVP Yes SBE P
• Men over the age of 45 with MVP even if no
  Doppler MR or murmur

14
Guidelines are silent on

• Right sided regurgitant lesions
• Aortic sclerosis with no gradient
• MR in dilated CM due to stretched out otherwise
  normal MV
• Mitral annular calcium of leaflet thickening
  without MR
• Mild degenerative changes in the elderly

15
(No Transcript)
16
Your cases