Re: Surgical Prophylaxis for MVP
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Sep 21 19:42:39 2006
Agree - it's a matter of risks/benefits - including myself ..
Ef
> At Thu, 21 Sep 2006, 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:
>> >> >
>
>l
>> >> >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
>> >> >>>>
>
>s
>..
>> >> >>>> (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
>
>o
>> >> >>>>> 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
>
>..
> Hippocrates
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
