MVP and Antibiotics

[Bil-Bailey]

Posted By  CCF Cardio MD-SGM on October 24, 1997 at 07:27:38:

In Reply to: MVP and Antibiotics posted by Bill Bailey on October 22, 1997 at 08:24:36:

: Approximately 10 years ago, I was diagnosed, almost by accident,
  with MVP. I was 35 at the time and had no known symptoms throughout
  my life.
  One of the specific instructions at the time, was to advise my dentist
  in advance of dental work so that antibiotics could be prescribed. I have
  followed that faithfully for over a decade.
  Recently, I visited mt dentist again. This time, he questioned the necessity of antibiotics in dental treatments. He felt that the thinking
  was antiquated, but said I should seek further information.
  What is the cuurent thinking on this subject? Must a course of antibiotics be taken prior to treatment?
  Thanks,
  Bill

[CCF Cardio MD-SGM]

Dear Bill,
This is a very interesting question that has a simple answer. First, let me say that the criteria for the diagnosis of mitral valve prolapse have become more stringent over the past two decades. That is to say that MVP may have been overdiagnosed in the past, and a reexamination of a cardiac echocardiogram with the benefit of hindsight may reveal that many people diagnosed with MVP ten years ago in fact have only slightly redundant mitral valvular tissue, and not prolapse.  This distinction is important, because we now understand much better the clinical significance of prolapse, and can advise patients more knowledgeably.  
So, first thing to do is get a follow-up cardiac examination and echocardiogram from an experienced cardiologist to see if the diagnosis is correct.  If you have MVP, it is important to determine whether there is a murmur of mitral regurgitation on your physical examination, and whether there is evidence of anything more than trivial regurgitation on the echocardiogram. If the answer to these questions is yes, then you are advised to take antibiotic prophylaxis prior to dental cleaning and other invasive procedures that may increase your risk of developing infection of the heart valves—endocarditis.  On the other hand, patients with MVP who have no evidence of significant regurgitation(leaking) of the mitral valve do not need to take antibiotic prophylaxis, as their risk of endocarditis not much different than that of the general population(no significantly increased risk).  In these patients, an echocardiogram is recommended every five years to look for progression of mitral valve disease.
Hope I’ve answered your questions.  Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your physician.