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Review
. 2023 Oct 13;120(41):692-702.
doi: 10.3238/arztebl.m2023.0104.

Patients with Artificial Heart Valves

Carolyn Weber  1 , Christopher Hohmann, Oliver Lindner, Thorsten Wahlers, Norma Jung
Affiliations
Review

Patients with Artificial Heart Valves

Carolyn Weber et al. Dtsch Arztebl Int. .

Abstract

Background: In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising.

Methods: We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature.

Results: Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses.

Conclusion: Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.

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Figures

Figure 1
Figure 1
Florid endocarditis nine months after aortic valve replacement: intense F-18-FDG enhancement in the area of the annulus, extending medially. a) computed tomography, b) positron emission tomography, c) fused PET and CT (Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center of North Rhine-Westphalia).
Figure 2
Figure 2
Explanted biological heart valve prosthesis. The black arrows mark attached vegetations. a) View from the aorta. b) View from the ventricle.
eFigure
eFigure
The number of cases of endocarditis per year in 5 German cardiac surgery centers from 1994 to 2016.
See this image and copyright information in PMC

References

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