What is the dermatologic preoperative evaluation and management of artificial heart valves?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

In addition to inquiring about the presence of a pacemaker, physicians should ask about artificial heart valves and other valvular heart diseases, such as aortic stenosis, mitral valve prolapse, mitral stenosis, rheumatic heart disease, and a history of infective endocarditis. Many patients are not familiar with these medical terms and diseases. A good general question to ask is if the patient has ever had to take antibiotics before a surgical procedure or a dental visit.

Consensus exists on the use of antibiotic prophylaxis against endocarditis before certain procedures in patients with certain cardiac conditions. In a review of the literature on endocarditis precipitated by skin procedures, Spelman et al found only 4 cases of endocarditis following skin procedures in which no prophylaxis was given. [13] The skin procedures included cryoremoval of a nevus, a punch biopsy, acupuncture, and excision of 3 melanomas from the head and the neck. Three of these patients were known to have abnormal cardiac valves at the time of the procedure, and 2 of these 3 had prosthetic valves. This study recommended that patients with valvular heart disease or prosthetic valves should receive antibiotic prophylaxis before punch and incisional skin biopsies or excisions.

Table 2. Endocarditis Antibiotic Prophylaxis Regimens for Cutaneous Procedures (Open Table in a new window)

Antibiotic

Dose 1 Hour Prior to Procedure

Dose 6 Hours After Procedure

Cephalexin

1 g orally

0.5 g orally

Dicloxacillin

2 g orally

1 g orally

Clindamycin*

300 mg orally

150 mg orally

Erythromycin*

1.5 g orally

0.5 g orally

Vancomycin*

1 g intravenously

None

*Alternative regimens for patients allergic to penicillin.


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