Tag Archives: infective endocarditis

Dear Sirs, There has been much debate regarding the prophylactic prescribing of antibiotics in patients deemed at risk of developing infective endocarditis (IE) as a result of certain dental procedures.1 The National Institute for Health and Care Excellence (NICE), the British Society for Antimicrobial Chemotherapy (BSAC) and the American Heart Association (AHA) have produced differing guidelines for dental practitioners, who may decide to accept one particular code entirely, or a modified version based on discussion with local cardiology departments. This culture of debate amongst cardiologists, dentists and patients regarding best interest,

The case study in this issue (see pages 46–7) demonstrates a potential use of CT scanning in the diagnosis of a patient with endocarditis. Electrocardiogram (ECG)-gated multi-detector cardiac computed tomography (MDCT) scanning has been proposed by many to have potential in the evaluation of endocarditis by demonstration of vegetations, complications (coronary artery occlusion, fistulae) and peripheral embolism.3 The major limitations of the technique include availability, spatial resolution, failure to demonstrate leaflet perforations and lack of haemodynamic information (table 1). Further, CT findings have not been correlated with clinica

Figure 1. Transoesophageal echocardiogram image. Hollow arrow marks abscess anterior to a bicuspid aortic valve (AV) and below the level of the pulmonary valve (PV). Solid arrow marks vegetation on the posterior aspect of the aortic valve TOE confirmed a 0.8 cm vegetation at the posteriorcommissure of the aortic valve with an ill-defined, 1.6 cm diameter, loculated lesion anterior to the valve pressing into the right ventricular outflow tract. This was felt to be an abscess cavity (hollow arrow, figure 1). TOE showed no involvement or impairment of flow throughout the length of the left main stem (LMS) or proximal right coronary arteries (LMS

NICE guidance The NICE review tried to determine which cardiac conditions are associated with increased risk of IE; whether dental treatment is associated with acute risk of developing the condition and whether ABP was effective in prevention of cases and deaths. The NICE guideline concluded that patients with structural heart disease were at increased risk of IE but did not find convincing evidence that dental ABP was cost-effective. They calculated that if amoxicillin prophylaxis was effective then the cost of preventing a single case of IE would be circa £12 million. In the absence of high-quality evidence for clinical effectiveness the

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