How do you approach mitral valve endocarditis associated with a large vegetation size and severe mitral regurgitation, but without any heart failure, hemodynamic instability or valve destruction?
While the current guidelines favor early surgery (within 48 hrs of diagnosis) for this population based on the results of the EASE trial (link attached), some favor antibiotic therapy for a few weeks prior to surgery to increase the chances for mitral valve repair instead of valve replacement.
Answer from: at Community Practice
This is a great question and it poses the risk-benefit of the situation nicely. This stems off the 2012 NEJM (Kang et al., PMID 22738096) paper linked in the question, comparing Early (<48 hr) vs Conventional/Abx treatment for large vegetation (>10 mm) without major stroke yet. Summary: this w...
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Answer from: at Community Practice
In case of large valvular vegetations with the potential for valvular destruction and abscess formation, early intervention is recommended based on the size of the valvular vegetation.
In spite of the fact that the patient does not have congestive heart failure in the setting of severe mitral regur...
Answer from: at Community Practice
It is important to get CVS involved early and to work with ID to coordinate antibiotics pre-op. We have sometimes given a week or two of antibiotics to prep the patient for definitive treatment with surgery but the risks of stroke, heart block, or hemodynamic collapse are real. I usually tell the pa...
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at Mercy Health The Heart Institute Fairfield
This patient needs surgery ASAP before that bad bo...
This patient needs surgery ASAP before that bad bo...