Prevention of an endocarditis

Description:

For general practitioners and cardiologists questions of prevention of IE of the native valve have the greatest value. In this regard in article they are discussed in more detail. The risk of IE of the native valve is defined:

    * massiveness and duration of the bacteremia arising after medical and diagnostic manipulations and procedures;
    * the condition of an endothelium (valve and pristenochny) defining a possibility of fixing and colonization of microbic bodies;
    * immunological status of a macroorganism

The greatest danger to the patient is constituted by the manipulations which are followed by massive and long bacteremia. On modern representations, prevention of IE of the native valve is performed in the eradikation mode (elimination of the microbic bodies which got to a blood stream), having rather high risk of iatrogenic complications and thereof constituting potential danger to the patient.

According to experts of the American Association of cardiologists, prevention of IE is recommended after:

    * the dental interventions complicated by bleeding;
    * tonsilectomies, adenoidectomies;
    * surgical removal of the site of a mucous membrane of a gastrointestinal or respiratory path;
    * sclerotherapies varicose expanded veins of a gullet and its dilatation;
    * ureter dilatation;
    * surgical treatment of pathology of urinary tract (including a prostatectomy);
    * the long catheterization of a bladder complicated by an infection;
    * vaginal hysterectomy;
    * the infected childbirth;
    * a section and drainage of the infected fabrics

Prevention of IE usually is not carried out at patients with small and moderate risk of IE after the procedures and manipulations complicated by small and short-term bacteremia:

    * the dental manipulations which are not complicated by bleeding;
    * injections of local anesthetics;
    * introductions of a timpanostomichesky tube;
    * introductions of an endotracheal tube;
    * bronkhoskopiya the soft endoscope (with a biopsy mucous or without it);
    * bladder punctures

Prevention of IE usually is not recommended to patients with any risk degree of IE after:

    * not infected urethra catheterizations;
    * works as the curette in a vagina;
    * the uncomplicated childbirth and abortions which are carried out in treatment and prevention facility;
    * removals of intrauterine spirals;
    * sterilizing procedures;
    * laparoscopies;
    * removals of milk teeth

The probability of emergence of IE is defined by efficiency of endothelial clearance of microbes.

The risk of IE at the patients having is highest:

    * IE episodes in the anamnesis;
    * the implanted valve prosthesis;
    * inborn heart diseases of "blue" type;
    * open arterial channel;
    * defects of mitral and aortal valves with regurgitation;
    * defect of an interventricular partition;
    * aorta coarctation;
    * iatrogenic aorto-pulmonic shunt
    * and having heart diseases with the residual disturbances which remained after surgical correction

The moderate risk of emergence of new cases of IE characterizes the patients suffering:

    * a prolapse of the mitral valve from regurgitatsny;
    * "pure" mitral stenosis;
    * tricuspid heart disease;
    * pulmonic stenosis;
    * asymmetric hypertrophy of an interventricular partition;
    * degenerative diseases of valves at young age
    * and the having bikuspidalny aortal valve or the combined aortal defect with the minimum hemodynamic disturbances;
    * the minimum residual disturbances in the first 6 months after correction of heart disease

The low risk of IE is noted at patients:

    * with a prolapse of the mitral valve without regurgitation;
    * with a prolapse of the mitral valve with the regurgitation determined only by tool methods;
    * having the high isolated defects of an interatrial partition;
    * with a coronary disease of heart;
    * with rheumatic damages of heart without valve dysfunction;
    * transferred aortocoronary shunting;
    * the heart diseases which had surgical correction with the minimum residual defeats (6 months later after operation)

To patients with predisposition to an endocarditis – the patients with certain disturbances of operation of valves of heart having an infectious endocarditis (a pericardium inflammation) or who received prostheses of valves of heart before some dental interventions (removal of a dental calculus, treatment of a periodontal disease, an odontectomy, a root top resection, all operational dental interventions) have to accept certain antibiotics. Without such "protection" by antibiotics of a bacterium can get to blood (bacteremia) and even to become a cause of illness an endocarditis.