Page 144 - Clinical Pearls in Cardiology

132 Clinical Pearls in Cardiology

• Unrepaired cyanotic congenital heart disease
(including palliative shunts and conduits)
• Completely repaired congenital heart defect during
the first 6 months after the procedure
• Repaired congenital heart disease with residual
defects at the site
• Cardiac transplantation recipients who develop
cardiac valvulopathy.
Prophylaxis is no longer recommended for any other
form of native valve disease (including conditions like
bicuspid aortic valve, mitral valve prolapse and calcific
aortic stenosis).
7. When is surgical intervention indicated in a case of
endocarditis?
The important complications that necessitate surgical
intervention in a patient with native valve endocarditis
are the following:
1. Congestive heart failure refractory to standard
medical therapy: Heart failure is the most frequent
and severe complication of endocarditis. Unless
severe comorbidity exists, the presence of heart
failure is an indication for early surgical intervention.
2. Recurrent septic emboli: The brain and spleen are
the most frequent sites of embolism in left-sided
endocarditis. Pulmonary embolism is frequent in
right-sided and pacemaker-related endocarditis. The
risk of embolism is the highest during the first
2 weeks of antibiotic therapy and is clearly related to
the size and mobility of the vegetation.
3. Persistent sepsis after 72 hours of appropriate
antibiotic treatment.
4. Rupture of an aneurysm of the sinus of valsalva.
5. Conduction disturbances caused by a septal abscess.