Prosthetic endocarditis

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Prosthetic valve (also English. Prosthetic Valve infection or Prosthetic Valve Endocarditis , shortly PVE) is an infection of the artificial heart valve . They are often found with perioperative contamination of the heart valve or with chronic, intravenous drug abuse .

Symptoms & diagnostics

Patients with PVE suffer from fever , increased infection parameters in the blood analyzes ( CRP , leukocytosis , granulocytosis, sedimentation rate ).

Microbiological blood cultures are positive for the pathogen , but usually need a few days before a usable result is available. With the blood culture it is also possible to isolate the pathogen and to test its sensitivity to different antibiotics ( antibiogram ).

The entry points for the germs can only rarely be found. It can be any type of wound .

A representation of the (artificial) heart valve using ultrasound can show colonies of germs (including vegetation ), but does not provide any information about the type of germ. Due to the advanced image quality of the ultrasound devices , other imaging methods such as computed tomography (CT) or magnetic resonance imaging (MRI or MRI) are usually not indicated.

therapy

Acute therapy

With a PVE, the stabilization of the patient (cardiovascular system) is in the foreground. In addition, antimicrobial therapy ( antibiotic ) must be started (first with a broad spectrum antibiotic, better a combination of broad spectrum antibiotics such as amoxicillin , gentamicin and / or rifampicin ). Later, if the pathogen antibiogram is known , the therapy is changed depending on the sensitivity of the pathogen. The antibiosis kills the pathogens in the blood and, under certain circumstances, cleans up existing stray foci, but germs can still be present on the heart valve in a biofilm, which allow the inflammation to flare up again after the antibiosis has ended. Replacing the heart valve prosthesis is therefore often seen as unavoidable (depending on the patient's condition and operative risk) and often represents a (life)-threatening emergency.

Operative therapy

The safest therapy for PVE is surgical removal and replacement of the infected heart valve.

literature

  • Walter R. Wilson et all: Prosthetic Valve Endocarditis. In: Annals of Internal Medicine , 1975; 82 (6): 751-756. doi : 10.7326 / 0003-4819-82-6-751 ( online )
  • TS Ivert, WE Dismukes, CG Cobbs, EH Blackstone, JW Kirklin, LA Bergdahl: Prosthetic valve endocarditis. In: Circulation. Volume 69, Number 2, February 1984, pp. 223-232, PMID 6690095 . ( PDF )
  • C. Piper, R. Körfer, D. Horstkotte: Prosthetic valve endocarditis. In: Heart (British Cardiac Society). Volume 85, Number 5, May 2001, pp. 590-593, PMID 11303018 , PMC 1729722 (free full text) (review).
  • P. Tornos: Management of prosthetic valve endocarditis: a clinical challenge. In: Heart (British Cardiac Society). Volume 89, Number 3, March 2003, pp. 245-246, PMID 12591815 , PMC 1767588 (free full text).
  • JW Gnann, WE Dismukes: Prosthetic valve endocarditis: an overview. In: heart. Volume 8, Number 6, December 1983, pp. 320-331, PMID 6363238 (Review).

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