Warning:
• Any valve must consult a cardiologist once a year.
• The Doppler echocardiography is the most accurate monitoring technology.
• The infective endocarditis prophylaxis is no longer systematic in most cases, but a periodic dental check is imperative (2 times per year).
• Avoid piercing, tattoos.
• Blood cultures in doubt
Clinic:
The patient to be operated on or not being monitored:
– The appearance or worsening of functional signs,
– The appearance of signs of heart failure, unexplained fever
– Modification of the usual auscultation (out detail), knowing that auscultation in denture wearers is difficult +++ (aortic prosthesis: always pathological diastolic murmur)
– Research and treatment for possible infection +++.
Paraclinic:
Monitoring includes ECG and echocardiography annual or more frequent if the valve disease is severe or progressive.In case of non-operated valve disease, it aims to define precisely the moment of a more radical treatment (surgery ++, or any balloon valvuloplasty for mitral stenosis).
Prophylaxis of infective endocarditis:
biannual audit of the dental condition.
Dental preceded mouthwashes (Hextril). Antibiotic therapy is imperative that patients at high risk of endocarditis ++ or if very dilapidated oral condition and poor oral hygiene, and in the opinion of the dentist.
Evoking endocarditis in cases of unexplained prolonged fever in all valvular ++ and do blood cultures +++
Treat aggressively with antibiotics intercurrent infection.
For acts involving the upper airway during dental care
When dental and acts on the upper aerodigestive tract with general anesthesia
In urogenital and digestive interventions
This antibiotic respect to high-risk heart disease (patients with prosthetic valves, infective endocarditis history, cyanotic congenital heart disease).
It can also be applied to heart disease risk called “moderate” (bicuspid aortic valve, aortic stenosis, significant mitral or aortic regurgitation, hypertrophic cardiomyopathy, congenital heart acyanotic – except ASD who do not complicate endocarditis) a diabetic or immunocompromised patients, and as we have said, in case of poor oral hygiene.
Gestures requiring antibiotic prophylaxis in these subjects are:
– Oral: all interventions,
– ENT: tonsillectomy, adenoidectomy, nasotracheal intubation,
– Gastrointestinal: Esophageal dilations, laser esophageal variceal sclerosis, colonoscopies and rectosigmoïscopies if cancerous lesion, digestive action on an infected organ (colon, bladder …). Cholangiographies retrograde, colonoscopies and rectosigmoïdoscopies,
– Urogenital: uretero pyélocalicielles maneuvers, interventions and biopsies regarding prostate and urinary tract lithotripsies,
– Skin: gesture on infected tissue.
