Valvular heart disease primary prevention

Valvular heart disease Microchapters

Patient Information

Classification

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral valve prolapse
Mitral regurgitation
Tricuspid stenosis
Tricuspid regurgitation
Pulmonary stenosis
Pulmonary regurgitation

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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## Endocarditis Prophylaxis

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## 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[1]

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#### Recommendations for Endocarditis Prophylaxis

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Class IIa

"1. Prophylaxis against infective endocarditis (IE) is reasonable for the following patients at highest risk for adverse outcomes from IE before dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa.

* Patients with prosthetic cardiac valves
* Patients with previous IE
* Cardiac transplant recipients with valve regurgitation due to a structurally abnormal valve
* Patients with congenital heart disease (CHD) with:

* Unrepaired cyanotic CHD, including palliative shunts and conduits
* Completely repaired congenital heart defect repaired with prosthetic material or device, whether placed by surgery or catheter intervention, during the first 6 months after the procedure
* Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (Level of Evidence: B)"

Class III (Harm)

"1. Prophylaxis against infective endocarditis (IE) is not recommended in patients with valvular heart disease who are at risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection. (Level of Evidence: B)"

## 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Endocarditis and Rheumatic Fever Prophylaxis (DO NOT EDIT) [2]

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### Recommendations for Endocarditis Prophylaxis

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Class I

"1. Prophylaxis against infective endocarditis is recommended for the following patients:

* Patients with prosthetic heart valves and patients with a history of infective endocarditis. (Level of Evidence: C)
* Patients who have complex cyanotic congenital heart disease (e.g., single-ventricle states, transposition of the great arteries, tetralogy of Fallot). (Level of Evidence: C)
* Patients with surgically constructed systemic pulmonary shunts or conduits. (Level of Evidence: C)
* Patients with congenital cardiac valve malformations, particularly those with bicuspid aortic valves, and patients with acquired valvular dysfunction (e.g., rheumatic heart disease).(Level of Evidence: C)
* Patients who have undergone valve repair. (Level of Evidence: C)
* Patients who have hypertrophic cardiomyopathy when there is latent or resting obstruction. (Level of Evidence: C)
* Patients with MVP and auscultatory evidence of valvular regurgitation and/or thickened leaflets on echocardiography. (Level of Evidence: C) "

Class III (Harm)

"1. Prophylaxis against infective endocarditis is not recommended for the following patients:

* Patients with isolated secundum atrial septal defect. (Level of Evidence: C)
* Patients 6 or more months after successful surgical or percutaneous repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus. (Level of Evidence: C)
* Patients with MVP without MR or thickened leaflets on echocardiography. (Level of Evidence: C)
* Patients with physiological, functional, or innocent heart murmurs, including patients with aortic valve sclerosis as defined by focal areas of increased echogenicity
* and thickening of the leaflets without restriction of motion and a peak velocity less than 2.0 m per second. (Level of Evidence: C)
* Patients with echocardiographic evidence of physiologic MR in the absence of a murmur and with structurally normal valves. (Level of Evidence: C)
* Patients with echocardiographic evidence of physiological TR and/or pulmonary regurgitation in the absence of a murmur and with structurally normal valves. (Level of Evidence: C) "

## References

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1. ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ Bonow RO, Carabello BA, Kanu C; et al. (2006). "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". Circulation. 114 (5): e84–231. doi:10.1161/CIRCULATIONAHA.106.176857. PMID 16880336. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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