Aortic stenosis precautions and prophylaxis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. infective endocarditis. The American Heart Association recommended that prophylaxis against infective endocarditis be limited only to patients with either prosthetic heart valves, previous episode(s) of endocarditis, or with certain types of congenital heart disease. Patients with severe aortic stenosis should avoid strenuous exercise and any exercise that greatly increases afterload such as weight lifting.
Antibiotic Prophylaxis
Aortic stenosis of any etiology is associated with a higher rate of infection of the stenosed valve, i.e. infective endocarditis.[1] To reduce the risk of developing infective endocarditis among high-risk patients, antibiotic prophylaxis should be considered prior to certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of esophageal varices, dilation of esophageal strictures, gastrointestinal surgery where the intestinal mucosa will be disrupted, prostate surgery, urethral stricture dilation, and cystoscopy. Note that routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.
Not withstanding the foregoing, the American Heart Association has changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:[2][3]
- Prosthetic cardiac valve or prosthetic material used for cardiac valve repair.
- Previous episode(s) of endocarditis
- Congenital heart disease (CHD)
- Unrepaired cyanotic CHD, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure.
- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization).
- Cardiac transplantation recipients who develop cardiac valvulopathy.
Vigorous Exertion
Given the risk of myocardial ischemia and sudden cardiac death, patients with severe aortic stenosis (< 1.0 cm2) should avoid strenuous physical activity including weightlifting and other activities that increase afterload.
References
- ↑ Michel PL, Acar J (1995). "Native cardiac disease predisposing to infective endocarditis". Eur Heart J. 16 Suppl B: 2–6. PMID 7671919.
- ↑ Thornhill MH, Dayer M, Lockhart PB, Prendergast B (2017). "Antibiotic Prophylaxis of Infective Endocarditis". Curr Infect Dis Rep. 19 (2): 9. doi:10.1007/s11908-017-0564-y. PMC 5323496. PMID 28233191.
- ↑ Wilson, Walter; Taubert, Kathryn A.; Gewitz, Michael; Lockhart, Peter B.; Baddour, Larry M.; Levison, Matthew; Bolger, Ann; Cabell, Christopher H.; Takahashi, Masato; Baltimore, Robert S.; Newburger, Jane W.; Strom, Brian L.; Tani, Lloyd Y.; Gerber, Michael; Bonow, Robert O.; Pallasch, Thomas; Shulman, Stanford T.; Rowley, Anne H.; Burns, Jane C.; Ferrieri, Patricia; Gardner, Timothy; Goff, David; Durack, David T. (2007). "Prevention of Infective Endocarditis". Circulation. 116 (15): 1736–1754. doi:10.1161/CIRCULATIONAHA.106.183095. ISSN 0009-7322.