Re: Surgical Prophylaxis for MVP
From: Efrain Ramirez (eramirezt@coqui.net)
Fri Sep 22 06:19:00 2006
Maybe - but I'll keep using EFHRM and prophylaxis for MVP - again- it's
a matter of risks/benefits ratio - including myself and my family..
Ef
>At Thu, 21 Sep 2006, Henry Gregor wrote:
>
>Isn't MVP prophylaxix one of those intuitive practices - like continuous fetal heart rate monitoring - that got adopted and then enshrined as a standard of care absent any definitive scientific studies demonstrating safety and efficacy?
>
> Hank
>
>"R. Daniel Braun" <rd.braun@gmail.com> 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
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
