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Treatment of infective carditis and rheumatic heart disease
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Treatment of Infective Carditis and Rheumatic Heart Disease. Including Valve Replacement. Infective Endocarditis Vegetation. Avascular Lack of WBCs Inactive bacteria Metabolically Growth. Infective Endocarditis Antibiotics. Aggressive antibiotic therapy used

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Treatment of Infective Carditis and Rheumatic Heart Disease

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Treatment of infective carditis and rheumatic heart disease

Treatment of Infective Carditis and Rheumatic Heart Disease

Including Valve Replacement


Infective endocarditis vegetation

Infective Endocarditis Vegetation

  • Avascular

  • Lack of WBCs

  • Inactive bacteria

    • Metabolically

    • Growth


Infective endocarditis antibiotics

Infective Endocarditis Antibiotics

  • Aggressive antibiotic therapy used

  • Bugs and resistance need to be known

  • Empirical therapy: Vancomycin, Gentamicin± Ceftriaxone (if prosthetic valve)

  • Only use ET if culture negative, urgent treatment, etc.


Infective endocarditis surgery

Infective Endocarditis Surgery

  • Congestive heart failure from valvular dysfunction

  • Unstable prosthetic valve

  • Ineffective antimicrobial therapy (e.g. fungus, resistant bacterial strains)

  • Relapse of prosthetic valve endocarditis

  • Large vegetations with risk of embolism

  • Persistent unexplained fever >10 days in culture negative endocarditis


Rheumatic heart disease

Rheumatic Heart Disease

  • Penicillin and Aspirin (analgesic)

  • Monthly penicillin till age 21

  • Vasodilation: ACE inhibitors

  • Mitral valve surgery (repair or replacement)

    • EF < 60%

    • Heart Failure

    • LV end diastolic diameter < 40mm (adult)

  • Mitral balloon valvuloplasty

    • Valve < 1.5cm2 AND progressive exertional dyspnoea

  • Aortic valve surgery (repair or replacement)

    • EF < 55%

  • Good article on management of RHD in Australia (big focus on indigenous populations) – see below

Walsh, W. F. (2010). "Medical Management of Chronic Rheumatic Heart Disease." Heart, Lung and Circulation 19(5-6): 289-294. http://www.ncbi.nlm.nih.gov/pubmed/20451453


Replacing the valve

Replacing the valve

  • Valve surgery not common in Australia - hence lack of expert surgeons

    • Recommendation that it is only done in specific centres in Australia to consolidate knowledge and expertise

  • Repair is preferred to replacement

  • Rheumatic valve surgery is technically more difficult than non rheumatic

  • The Ross procedure

    • Remove patient's aortic valve

    • Move patient's pulmonary valve to aorta

    • Replace pulmonary valve with allograft (organ donor)


Choosing the valve

Choosing the valve


The on x valve

The On-X Valve

  • May "revolutionise" heart surgery!!

  • Currently undergoing trials

http://www.healthcentral.com/heart-disease/valve/benefits_of_onx_valve.html


References

References

  • Walsh, W. F. (2010). "Medical Management of Chronic Rheumatic Heart Disease." Heart, Lung and Circulation 19(5-6): 289-294. http://www.ncbi.nlm.nih.gov/pubmed/20451453

  • Aboud, A., M. Breuer, et al. (2009). "Quality of life after mechanical vs. biological aortic valve replacement." Asian CardiovascThorac Ann 17(1): 35-38. http://asianannals.ctsnetjournals.org/cgi/reprint/17/1/35

  • Bashore Thomas M, Granger Christopher B, Hranitzky Patrick, Patel Manesh R, "Chapter 10. Heart Disease" (Chapter). McPhee SJ, Papadakis MA: CURRENT Medical Diagnosis & Treatment 2011: http://www.accessmedicine.com/content.aspx?aID=3671.

  • http://www.healthcentral.com/heart-disease/valve/benefits_of_onx_valve.html

  • Carapetis Jonathan R, "Chapter 315. Acute Rheumatic Fever" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2881861.

  • Pinney Sean P, Mancini Donna M, "Chapter 32. Myocarditis and Specific Cardiomyopathies" (Chapter). Fuster V, O’Rourke RA, Walsh RA, Poole-Wilson P, Eds. King SB, Roberts R, Nash IS, Prystowsky EN, Assoc. Eds.: Hurst's The Heart, 12e: http://www.accessmedicine.com/content.aspx?aID=3047358.

  • Karchmer Adolf W, "Chapter 118. Infective Endocarditis" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2881448.


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