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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. 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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  1. Treatment of Infective Carditis and Rheumatic Heart Disease Including Valve Replacement

  2. Infective Endocarditis Vegetation • Avascular • Lack of WBCs • Inactive bacteria • Metabolically • Growth

  3. 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.

  4. 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

  5. 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

  6. 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)

  7. Choosing the valve

  8. The On-X Valve • May "revolutionise" heart surgery!! • Currently undergoing trials http://www.healthcentral.com/heart-disease/valve/benefits_of_onx_valve.html

  9. 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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