Re: Surgical Prophylaxis for MVP
From: Rafael Haciski (haciski@earthlink.net)
Thu Sep 21 16:15:14 2006
How does one determine the presence of regurgitation?
... by the echocardiogram?
... presence of murmur?
Usually when I pick out a heart murmur on exam, then i refer to
cardiologist, and invariably they get an echo, which then may show
prolapse (how can you not have regurge with prolapse, I do not
understand), or not. And almost never do they come back to me with
statement as to whether the pt needs SBE proph or not, I usually have
to call them back and ask that question specifically!
Rafael Haciski MD FACOG
Palmetto, FL
On Sep 21, 2006, at 7:06 AM, R. Daniel Braun wrote:
> If you get an echo on everybody, 5% will have MVP. Only those who
> also have regurge are of any significance. And even they don't need
> SBE prophylaxis.
>
> Dan
>
> On 9/20/06, Efrain Ramirez <eramirezt@coqui.net> wrote:
> Strangely enough my MVP patients - confirmed by ECHO are very few -
> Cardiologists themselves tell those patients to get prophylaxis--
>
> Ef
>
> At Wed, 20 Sep 2006, R. Daniel Braun wrote:
> >
> >So, you are giving SBE prophylaxis to 5% of all your patients.
> >
> >Dan
> >
> >On 9/19/06, Efrain Ramirez < eramirezt@coqui.net> wrote:
> >>
> >> All my patients with MVP get prophylaxis ... IMHO there is not
> good
> >> evidence against such a practice...
> >>
> >> Ef
> >>
> >> >At Tue, 19 Sep 2006, Garry E. Siegel, M.D. wrote:
> >> >
> >> >I have a copy of an AHA Scientific Statement, "Prevention of
> Bacterial
> >> >Enodcarditis," and you're right, it is from 1997. My error.
> >> >
> >> >Garry
> >> >
> >> >At Tue, 19 Sep 2006, Kim Elise Goldman wrote:
> >> >>
> >> >>Actually,
> >> >>the most recent update of the AHA recommendations for
> ENDOCARDITIS
> >> >>PROPHYLAXIS per the AHA itself is listed as the 1997 update.
> >> >>
> >> >>The determination of indication for ENDOCARDITIS PROPHYLAXIS
> is not
> >> >>made by ACOG.
> >> >>
> >> >>The exact AHA discussion of indications for ENDOCARDITIS
> PROPHYLAXIS
> >> >>and hysterectomy is reproduced here.
> >> >>
> >> >>Endocarditis prophylaxis not recommended
> >> >>Respiratory tract
> >> >> Endotracheal intubation
> >> >> Bronchoscopy using a flexible bronchoscope, with or
> without biopsy
> >> >> Tympanostomy tube insertion
> >> >>Gastrointestinal tract
> >> >> Transesophageal echocardiography †
> >> >> Endoscopy with or without gastrointestinal biopsy †
> >> >>Genitourinary tract
> >> >> Vaginal hysterectomy †
> >> >> Vaginal delivery †
> >> >> Cesarean section
> >> >>
> >> >> †--Prophylaxis is optional for high-risk patients.
> >> >>
> >> >>High risk is defined as:
> >> >> * All prosthetic heart valves (including bioprostheses and
> >> >>homografts).
> >> >> * Any history of previous bacterial endocarditis.
> >> >> * Complex cyanotic congenital heart disease and surgically
> >> >>constructed systemic pulmonary shunts.
> >> >>
> >> >>So, in fact, I was in error in stating that all vag hyst's
> might be
> >> >>
> >> >>TAH does not require ENDOCARDITIS PROPHYLAXIS as long as one
> stays
> >> >>out of the bowel.
> >> >>
> >> >>Cefazolin is considered an acceptable AHA endocarditis
> prophylaxis
> >> >>regimen for oral, respiratory, esophageal procedures but not
> for GU
> >> >>or GI (below esophagus) procedures.
> >> >>
> >> >>presurgical antibiotic prophylaxis vis a vis prevention of wound
> >> >>infection.
> >> >>
> >> >>risk.
> >> >>
> >> >>Hope that clears things up. :)
> >> >>
> >> >>Kim
> >> >>
> >> >>On Sep 19, 2006, at 1:31 PM, Garry E. Siegel, M.D. wrote:
> >> >>
> >
> >s
> >> >>> not a lesion requiring prophylaxis for endocarditis.
> >> >>>
> >> >>> Ancef is appropriate for the surgical site, of course.
> >> >>>
> >> >>> Garry
> >> >>>
> >> >>> At Tue, 19 Sep 2006, ainsron wrote:
> >> >>>>
> >> >>>> That is not correct, prophylaxis is indicated for TAH or
> Vag Hys,
> >> >>>> per ACOG
> >
> >s
> >> >>>> another issue. It is not recommended for laparoscopy.
> >> >>>>
> >> >>>> Ronald E. Ainsworth, MD, FACOG
> >> >>>>
> >> >>>> -----Original Message-----
> >> >>>> From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On
> Behalf Of
> >> >>>> Kim Elise
> >> >>>> Goldman
> >> >>>> Sent: Tuesday, September 19, 2006 5:18 AM
> >> >>>> To: Multiple recipients of list OB-GYN-L
> >> >>>> Subject: Re: Surgical Prophylaxis for MVP
> >> >>>>
> >> >>>> PS Abdominal surgery without entry into the aerodigestive
> tract is
> >> >>>> not an indication for endocarditis prophylaxis per AHA
> guidelines.
> >> >>>> (EG vag hyst indicated for prophylaxis but TAH probably not
> >> >>>> indicated.)
> >> >>>>
> >> >>>> Kim
> >> >>>>
> >> >>>> On Sep 19, 2006, at 7:44 AM, Joanne Bulley, MD wrote:
> >> >>>>
> >> >>>>> Hi folks,
> >> >>>>>
> >> >>>>> with
> >> >>>>> the subtlest of murmur - when doing a TAH (or other hyst)
> would you
> >> >>>>>
> >> >>>>> a) standard prophylaxis with cefazolin (Ancef)
> >> >>>>>
> >> >>>>> b) MVP / lower cardiac risk prophylaxis with ampicillin?
> >> >>>>>
> >> >>>>> My hospital pre-printed orders for the cardiac prophylaxis
> suggests
> >> >>>>> just
> >> >>>>> Ampicillin. But it also suggests it is needed for MVP
> only if
> >> >>>>> there is
> >> >>>>> regurg or thickened leaflets.
> >> >>>>>
> >
> >p
> >> >>>>> when the pre-op RN at the hospital asks the question and
> then who
> >> >>>>> knows
> >> >>>>> where the echocardiogram (if any) was done - and I get the
> phone
> >> >>>>> call
> >> >>>>> "she needs prophylaxis for MVP"
> >> >>>>>
> >> >>>>> What do you do in your institution? (I am always curious
> about how
> >> >>>>> folks
> >> >>>>> do things in different places around the globe - as there
> are so
> >> >>>>> many
> >> >>>>> variations because a lot of what we do does not have
> "final" EBM
> >> >>>>> answers.)
> >> >>>>>
> >> >>>>> --
> >> >>>>> Joanne Bulley, MD
> >> >>>>> Keene, NH, USA
> >> >>>>>
> >> >>> --
> >> >>> Garry E. Siegel, M.D.
> >> >>> Private Practice
> >> >>> Roswell, GA
> >> >>>
> >> >--
> >> >Garry E. Siegel, M.D.
> >> >Private Practice
> >> >Roswell, GA
> >> >
> >>
> >> --
> >> " The greatest obstacle to knowledge is not ignorance,
> >> it is the illusion of knowledge." Daniel J. Boorstin - Historian
> >>
> >--
> >R. Daniel Braun
> >
> >..
> > Hippocrates
> >
>
> --
> " The greatest obstacle to knowledge is not ignorance,
> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
> --
> R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage
> everyday".
> Hippocrates
