Dental Prophylaxis and Mitral Valve Repair

[turbocharged]

Four months ago I underwent a successful Mitral Valve Repair with a Duran ring. My cardiologist notes that since I have no residual mitral regurg, I no longer need dental prophylaxis.  I trust my cardiologist and have the utmost faith in him. Regardless, this worries me. He said he has never seen an endocarditis in this situation. How big can the denominator be with MVVs? And for a rare event, would he have seen enough to make the recommendation? Given that taking antibiotics is pretty easy, even if the risk is low, I opted to take some Amoxil when I went in last week for dental cleaning. Can I or should I forgo this precaution in the future?

[CCF-M.D.-MJM]

Hello,

The following are the ACC guidelines for antibiotics with valvular disease.

an artificial (prosthetic) heart valve
a history of previous endocarditis
heart valves damaged (scarred) by conditions such as rheumatic fever
congenital heart or heart valve defects
hypertrophic cardiomyopathy (hi"per-TRO'fik kar"de-o-mi-OP'ah-the)

It is interest that you specifically mention mitral valve repair because I couldn't find a guideline that directly address MV repair.  It sounds like you don't have to do it, but if  you feel more comfortable doing, I agree that risks of taking an antibiotic you already know that you are not allergic too is very low.

I hope this answers your question.  Good luck and thanks for posting.

[Bromley]

What is a Duran ring?

If this is an implanted material in contact with cardiac tissue, the guidelines may apply for the same reasons they apply to an artificial heart valve: possibility of endocarditis.  Perhaps the guidelines should be revised???

[turbo charged]

Thank you for your response. Bromley's comment reflects my question. To my chagrin, I'm not exactly sure what the composition is of a Duran Ring. The surgeon described it as "plastic" and based on my web-search, it's plastic. Either way, there is a foreign body in my heart.  My cardiologist's explanation for his reasoning included the comment that the ring rapidly becomes epithelialized thus negating the need for prophylactic antibiotics.

I couldn't find any mention of mitral valve repair recommendations either- I wonder how many patient years of people walking around with repairs we need to make a confident recommendation.

As far as having an antibiotic I can take without allergy, that depends on the level of comfort. I have yet to meet an antibiotic that doesn't set my tummy a rumblin. To be honest, I never took the antibiotics when they told me I absolutely needed to due to the myxometous valve. I happily believed that MVP was just a variant of normal. Then I developed regurg, and dilated atria, and a falling EF, and became a believer.  So it is ironic that now that I don't have to take the antibiotics, I'm concerned. Funny what having one's chest cracked open does to one's perspective on these matters....

[Momto3]

I'm not sure this is what you are looking for, but it may help.  The American College of Cardiology and the American Heart Association have issued a new set of practice guidelines for managing patients with valve disease (Aug 2006)  

http://www.americanheart.org/downloadable/heart/1150461625693ValvularHeartDisease2006.pdf

Check out page e13 -e15 -- Maybe this is what you're looking for.  Note that the guidelines indicated in this portion of the document (1997) are under review and subject to change.

I found the guidelines very informative and helpful in understanding my own situation.  

[1812gjm]

I had my mitral valve annuloplasty in September, 2006, and a ring was also implanted.  My surgeon (Washington University School of Medicine) tells me its imperative to premedicate with antibiotics for dental procedures.  The way I see it, it's a very inexpensive thing to premedicate.  Why take a chance?