Infection sources in HNO- and jawbone regions in patients before valve replacement surgery
II. Interne Abteilung mit Kardiologie und Intensivstation, Allgemeines offentliches Krankenhaus der Barmherzigen Schwestern vom Hl. Kreuz, Wels, Osterreich. elisabeth.lassnig@khwels.at
BACKGROUND: Prosthetic valve endocarditis is a life-threatening
complication after valve replacement surgery. Therefore, it
is common to perform a screening for potential sources of infection
before surgery in order to be able to do a prophylactic treatment.
PATIENTS AND METHOD: The incidence of potential infectious
sources of bacteremia in the dental, jaw and nasopharyngeal
area was evaluated in 92 patients going to have valve replacement
surgery. Screening examinations were an X-ray of the paranasal
sinuses and a panoramic radiograph of the dental arch. Chronic
apical periodontitis, cysts and remaining radices were counted
as dental sources. Each shadow in the paranasal sinuses X-ray
was seen as pathological and was further investigated by an
otorhinolaryngologist. RESULTS: A potential infectious source
was found in 49 patients. 42 patients had a dental infectious
source with need for treatment. 19 patients showed a pathologic
sinus X-ray (three aspergillomas, three sinusitis, the others
had a chronic polyposis with no need for treatment). Twelve
patients had dental as well as sinusoidal sources. Erythrocyte
sedimentation rate did not refer to the appearance of infectious
sources. Patients going to have a mitral valve replacement
had most dental sources (61%), 47% of the patients with planned
aortic valve replacement, 50% of the patients planned to get
more than one heart valve replaced, 50% of the patients getting
mitral valve replacement and CABG and 40% of the patients waiting
for aortic valve replacement and CABG had dental foci.
CONCLUSION:
Screening for infectious foci before valve replacement surgery
diagnosed foci in a high percentage of the patients. Nevertheless
current data concerning whether a prophylactic treatment may
reduce the incidence of prosthetic valve endocarditis are conflicting.
Publication Types:
• Clinical Trial
PMID: 15167959 [PubMed - indexed for MEDLINE]
