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Thread: Bovine valve and risk of infection

  1. #1
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    Default Bovine valve and risk of infection

    Hi,
    I'm trying to understand the risk of infection and my bovine heart valve. First, I am planning a trip to India this winter. Now, I know I need antibiotics for teeth cleaning or any surgery. Also, that if I think I have a local infection on my skin, or strep throat, I should see a doc immediately and get an antibiotic.
    What about with flu or other fever?

    Also, I know people traveling to other countries can get bacteria in their stomach?? and get sick. (I will bring Cipro) Would that be something to worry might spread to the heart valve? Or any other kind of bacteria you might pick up traveling? I had a friend with endocarditis and it took a long time to identify the bacteria....

    I will see a doc before I go, but wondered what wisdom anyone here might add?

    Thank you, Betsy
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  2. #2
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    These are excellent questions. I would have not given traveling and endocarditis a second thought until I recently had it for the first time. It was caused by a staph that lives on the skin, a rare one at that and no one knows how I got it. I had flu-like symptoms and 100.8 fever and the 1st ER I went to, on a mini vacation, told me it was the flu. Hah! Lucky for me, my own medical grp identified the bacteria in only days after the initial mis-diagnosis. I guess the thing to remember is that getting endocarditis is still relatively rare, only 29000 cases in the US last year.
    My cardio has told me that I was just unlucky to get it.
    I think that going to your doc and asking all the ?'s you have is the best scenario. Mainly because there are so many bacteria's out there, and each one may need a different antibiotic to treat it. I have known people who got staph and only needed to take oral antibiotics for 10 days, but I had to have it IV for 6 weeks. Basically, my staph went straight to my valves, and one was my natural, leaking mitral, and one was a mechanical.
    Just have a great time and try not to get too paranoid about it. Bring the antibacterial gel, and use it!

  3. #3
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    Thanks, Gail. How did they know the staph infection went to your valve? What were the symptoms and how fast did it happen?
    Betsy
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  4. #4
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    Quote Originally Posted by Gail in Ca View Post
    These are excellent questions. I would have not given traveling and endocarditis a second thought until I recently had it for the first time. It was caused by a staph that lives on the skin, a rare one at that and no one knows how I got it. I had flu-like symptoms and 100.8 fever and the 1st ER I went to, on a mini vacation, told me it was the flu. Hah! !
    Agreed .Good questions. For most people its very difficult to get endo,
    unless alot of bacteria just swamp your system and are traveling in the bloodstream.
    But for us since we have scar tissue or irregularity from surgery
    only a small amount of bacteria can get lodged in these crevices and begin
    to multiply.
    Same thing happened to me in '91,was misdiagnosed - twice! First it was
    a flu and later they said it was bronchitis...yeah right with a fever of over
    104.
    So now getting an everyday illness does worry me,I don't think its a probability,
    but I believe it is possible. Not so sure about virus tho,they may even be less likely
    to grow on our valve,but it is something else for us all to worry about



    Here are some symptoms:Fever-intermittent, Anorexia(loss of appetite),
    night sweats,weight loss, poor wound healing with infection and/or
    drainage(late symptom)Weakness and general malaise,
    some have cardiac symptoms like palpitations or pain,
    hemorrhogic lesions on fingernails, Shortness Breath and
    sometimes pneumonia occurs as a result of the endocarditis.

    It can be diagnosed easy with a culture or a echo .
    Last edited by Dina; June 30th, 2009 at 12:25 AM. Reason: adding
    Tricuspid Valve Replacement(Bovine)2/4/08
    A.Flutter x 3,with 2 ablations & cardioversion 2007
    "A little learning is a dangerous thing..."-by Alexander Pope

  5. #5
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    i was under the impression that valvers are no more likely to get endo
    than anyone else. maybe if you've had it before (and that's what caused
    valve problem in the first place) you might be more susceptible than most.

    once the infection is gone (and left a ruined valve), it's pretty much run
    its course. of course they'll do a blood test for endo, even though mine
    was 35 years or so prior.

    maybe someone knows for sure if this is true? i could be wrong.

    i'm going on the assumption that i'm predisposed to be susceptible to endo.
    just because of how my body is made, not because of the new valve.
    anyway, the new valve is dead meat, so shouldn't be able to 'catch a cold.'

    regardless, in the event of extended or high fever, i plan to request a
    blood test just to be sure.

  6. #6
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    We are definitely more likely to get endo post op,even if you never had
    it before. The big dangers are dental procedures because of all the staph
    in our mouths(YUK!),and any purulent or serious local infections esp if
    they have the possibility of traveling and becoming systemic.

    Maybe someone else will back me up...?
    Tricuspid Valve Replacement(Bovine)2/4/08
    A.Flutter x 3,with 2 ablations & cardioversion 2007
    "A little learning is a dangerous thing..."-by Alexander Pope

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    Quote Originally Posted by Dina View Post
    The big dangers are dental procedures because of all the staph in our mouths(YUK!)
    that's easy, next time at the dentists....don't bite the staff.

    didn't they just change the rules for dental antibiotic prophylaxis for valvers?
    the old rules (maybe???) were more of a just-in-case-be-overprotective
    thing rather than based on reality? i'm not sure and don't want anyone
    to quote me on this!!!

    doctor al should be able to clear this one up.

  8. #8
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    Hi Betsy.
    Two years ago I had to go through AVR due to Endocarditis. It all came so suddenly with flue-like symptoms such as feeling tired.. fever... rigors.... sweats, etc. I was treated with antibiotics to fight the initial faulse diagnosis of a sore throad. In just one month my malformed aortic valve was destroyed.
    The bad thing is that the bacteria responsible was never identified due to the fact that all blood cultures indicated a different type of bacteria due to the fact that I was fully loaded with antibiotics.
    I do not know how this nasty bacteria enterted my bloodsteam and this is one reason why I do not know how to protect myself. I am trying to keep all known ways of everyday hygiene, avoid using swimming pools, etc.
    My endocarditis was so strong that at the end I felt into a septic shock. Thanks to God and a good old friend that happened to be my surgeon I am alive and in excellent health (knock on wood).
    By the way, I have been informed that bacteria can only enter your bloodstream via a wound. Can this also happen through a sore throat?
    Regards:
    Petros

  9. #9
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    Good point, Petros. My friend, who had a similar endo story had so much antibiotic it was hard to identify bacteria. Maybe the thing to do is at sign of high fever, when going to doc, request blood sample be drawn before first antibiotic is given. I remember them culturing his blood for days and not getting results and finally something grew and was identified.

    ChoDoufu, I think that it is an artificial valve that has more of a chance of being infected, for some reason the bacteria goes straight there if your system is overloaded. From what I see below, we can get subacute endocarditis and looks like there are certain bacterias that are known to cause endocarditis.

    http://your-doctor.com/healthinfocen...alvedz.html#en

    Subacute endocarditis usually occurs on artificial or previously injured valves and progresses more slowly. Bacteria associated with subacute endocarditis are not as virulent as bacteria associated with acute endocarditis. Symptoms of subacute infective endocarditis,often not as obvious, may include:

    * recurrent fever
    * weight loss
    * decreased appetite
    * feeling very run down

    People often think they have recurrent flu or may have been treated with antibiotics several times with antibiotics for presumed bacterial infections such as bronchitis.

    As in the case of acute infective endocarditis bacterial vegetations can break loose and go to other parts of the body. Physical signs are related to the part of the body they lodge in:

    * small hemorrhages may be seen in finger and toe nail beds;
    * retinal hemorrhages may be seen in the eyes;
    * tender nodules (Osler nodes) may be felt on finger and toe tips;
    * nontender plaques (Janeway lesions) may occur on the palms of the hands and soles of the feet.

    Diagnosis of infective endocarditis is made if blood cultures are positive for bacteria or fungi known to cause endocarditis and there is evidence of valvular injury or vegetations. The heart and valves are imaged using echocardiography.

    Treatment generally requires hospitalization and intravenous antibiotic therapy for at least 4 weeks. Infection is almost never adequately treated with oral antibiotics. Persons with severe valvular destruction may require valve replacement.

    Prevention is extremely important because infective endocarditis is so difficult to treat and can cause severe disability or death. All persons with evidence of valvular injury or deformity should take preventative antibiotics before dental or surgical procedures are performed. If you have a known heart murmur or valvular problem consult your dentist and doctor prior to dental or surgical procedures.
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  10. #10
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    I think it's good to know about the possible risk of infection and understand it more thoroughly. I will be asking my cardio and doc so will post when I do.

    So, it seems the first step is with sign of fever, is to rule out common causes (flu, bronchitis). But that seems to be easily misdiagnosed (from reading posts here). Blood test seems to be smart, but do we have to do that every time we have fever? And then echo can show only already injured valve or vegetation?
    The key would be to diagnose the bacteria before any injury or vegetation.

    I do understand endocarditis is not that common, but I would like to understand guidelines for early diagnosis and exactly what is recommended when we have fevers.

    Gail, maybe you can tell us more about how your doc diagnosed your doc diagnosed your endocarditis so quickly.

    Thanks! Betsy
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  11. #11
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    When I had endocarditis (spring 2004), I had a low-grade fever, horrible headache, and I felt very run down. I didn't go to the ER until 13 days later (I wish I had gone earlier).

    When I had the first consultation with the surgeon who was to become my surgeon, he said that repairing the valve (I don't have details on replacement) reduces the risk significantly.

    However, I know that having had endocarditis previously increases the risk, so I don't know if the fact that I had an MV repair with previous endocarditis still puts me less at risk than what I was with severe regurgitation or more at risk because of previous endocarditis or at about the same risk as I was.

    Another thing I wanted to mention is that when I was being treated for endocarditis, the infectious disease specialist treating me told me that in the future, if I ever had a fever for what seemed to me no reason (no cold, no flu), to get to the ER (or call him) within the first couple of days.

    All this being said, I relate to your fear of getting it again!! I still travel, but it is always in the back of my mind.
    Mitral valve repair & maze procedure - October 20, 2005 - Montreal Heart Institute
    A-Fib - August 2005
    Endocarditis - 2004

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    Hmm, what was you low-grade fever, Adrienne? I ask because aside from asking about endocarditis because of a future travel, I also have had a sore throat, low grade fever 99.8, and head cold last 3 days. It feels like something I have had about 3 times since my surgery 1 1/2 years ago, and I twice got tested for step throat and it was negative and probably viral. I don't feel concerned because it feels like a head cold, maybe from being a bit stressed and run down. But then reading all these posts, I am wondering?? I was told by the doctor only to be concerned if fever hit 101 or higher???

    Thanks, Betsy
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

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    Quote Originally Posted by ChouDoufu View Post
    that's easy, next time at the dentists....don't bite the staff.

    didn't they just change the rules for dental antibiotic prophylaxis for valvers?
    .
    Ha-Ha! But if I don't bite them who will I take my anger out on

    If there were any guideline changes it was probably because they are trying to slow down the overuse of antibiotics,not because it is any less dangerous for us.I was able to get endo from a wisdom tooth extrction and this was before I had any heart problems at all.So I may feel differently about it since
    I experienced this first hand.
    Tricuspid Valve Replacement(Bovine)2/4/08
    A.Flutter x 3,with 2 ablations & cardioversion 2007
    "A little learning is a dangerous thing..."-by Alexander Pope

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    Quote Originally Posted by Dina View Post
    If there were any guideline changes it was probably because they are trying to slow down the overuse of antibiotics,not because it is any less dangerous for us.
    That is my opinion too.


    Quote Originally Posted by bbb View Post
    Hmm, what was you low-grade fever, Adrienne? I ask because aside from asking about endocarditis because of a future travel, I also have had a sore throat, low grade fever 99.8, and head cold last 3 days. It feels like something I have had about 3 times since my surgery 1 1/2 years ago, and I twice got tested for step throat and it was negative and probably viral. I don't feel concerned because it feels like a head cold, maybe from being a bit stressed and run down. But then reading all these posts, I am wondering?? I was told by the doctor only to be concerned if fever hit 101 or higher???

    Thanks, Betsy
    My temperature was more or less 38 C or around 100-100.5 F. I took Tylenol at night because the headache would become excrutiating, so who knows, maybe the fever would have been slightly higher during the night without the Tylenol.
    Mitral valve repair & maze procedure - October 20, 2005 - Montreal Heart Institute
    A-Fib - August 2005
    Endocarditis - 2004

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    Is it necessary to be hospitalized during IV treatment?
    Riding the INR bubble

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    Depends on what else is going on. My friend with endocardititis got IV antibiotics in hospital until he stabilized, then was sent home with pic line and administered it himself afterwards.
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  17. #17
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    I guess that's my biggest fear (other than a valve re-do) would be a loooong hospital stay.
    Riding the INR bubble

  18. #18
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    Default fast diagnosis

    I was diagnosed pretty fast, but it could've been faster, yet. I had a fever that never hit 101, aches in my back, joints, and especially in my rt shoulder.
    It came on so suddenly and by the evening(fri) it was the most pain I have ever experienced. I, like an idiot, assumed I was having a reaction to a flu shot just 2 wks prior, and thought my shoulder pain was from lifting my suitcase out of the car. After my misdiagnosis in the ER,(sat) just 3 days later at home, I saw blood in my urine.(tues) This was a first. I tested myself, 6.6, and again assumed it was the flu and my eating habits were different because I was so sick. My mom remembers talking to me and she thought I sounded sicker than she had ever heard me sound, just 2 days after that.(thurs) I went to urgent care because my protime wouldn't give me a reading, and that's where I was so lucky to have a good doc. I also complained of a severe headache the night before(wed) and she ordered many blood, urine tests and a ct scan of my head. So, the ct showed a brain bleed and inr of 9.3 and I was hospitalized immediately, given vit K and FFP.The hospital doc thought I had a possible arteritis because of the brain bleed. The next day,(fri) the test came back for the blood cultures and it was positive, so I was started on IV gentimycin, vancomycin and rifampin orally, hospitalized for 6 days, sent home with a picc line. Just 3 days later, I had a fever of 100.7,was in A-fib and was hospitalized again. My blood culture which had been neg at my release, had turned positive after 5 days. I was switched to nafciliin instead of vanco and the rest the same. They did a TEE and didn't see any vegetation on my valves, so they thought I was in the clear after the 6 wks of antibiotics. But, just a wk or so after the drugs were stopped, I started having crackling in my lungs when I awoke in the am, and a weird feeling in my chest when I walked uphill, also I had a back pain that was getting worse. Back to the hospital and another echo and TEE later, and a bulge was seen on my mech valve ring and my mitral was also leaking severely now instead of mod to severe.
    So, for me, the tests didn't show a problem with my valves until I was done with the treatment for endocarditis.
    And to answer the question of bacteria causing my original valve prob in 89, and so being suseptable to another infection, that wasn't the case. I had granulomatous aortitis, causing my AAA, which caused my aorta to leak as well. whew!

  19. #19
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    I was in the hospital for 5 days with IV penicillin and gentimycin. Then I was at home with a PICC line which delivered penicillin for 4 weeks. The penicillin bag had to be changed every day which because of all kinds of problems, I had it done every day at this local health clinic called a CLSC. Even with all the problems, it was sooo much better being at home than in the hospital!
    Mitral valve repair & maze procedure - October 20, 2005 - Montreal Heart Institute
    A-Fib - August 2005
    Endocarditis - 2004

  20. #20

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    Justin was in the hospital for about a week for vanco and gentomycin IVs. He then had 5 more weeks of IVs at home with a pic line. . He had then every 8 hours and we did all the IV's (he was 11 and they even taught him) and the home health nurse came out every couple days to change the dressing, check him out ect
    Lyn
    Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) www.caringbridge.org/nj/justinw

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    Gail, did they ever figure out what might have caused your endocarditis?
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  22. #22
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    Good site about prosthetic heart valves:

    http://emedicine.medscape.com/article/780702-overview

    Sounds like, if I am interpreting this right, there is not a huge risk of endocarditis for people with prosthetic heart valves:

    PVE (Prosthetic Valve Endocarditis) occurs in 2-4% of patients. The incidence is 3% in the first postoperative year, then 0.5% for subsequent years. The incidence is higher in mitral valves. Mechanical and biological valves are equally susceptible.
    _______________
    Betsy
    Bicuspid Aortic Valve Replacement and Aortic Aneurysm Repair
    Nov. 29, 2007 - Cleveland Clinic, Dr. Lars Svensson
    Carpentier-Edwards Bovine Pericardial Aortic Tissue Valve

  23. #23

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    Earlier you asked if you have to get blood cultures everytime you get a fever. We were told to get them if Justin had a fever /felt sick for a couple days. The only other time I remember having blood cultures done since (he had BE 10 years ago) he ended up having Mono. He did have blood cultures drawn when he had the infection in and under his sternum to see if it was in his blood stream, but it wasn't.
    Lyn
    Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) www.caringbridge.org/nj/justinw

  24. #24
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    Quote Originally Posted by Roger Frank View Post
    Is it necessary to be hospitalized during IV treatment?
    Just as a note to UK patients, expect to stay in hospital for the duration. I was in for almost six weeks and they injected me six times each 24 hours, so 2am included - no drip, just slow injections. I wasn't discharged until I was on oral antibiotics.
    Lithotripsy for kidney stones 8 December 2004.
    Began to feel unwell 19 December 2004, with hindsight, the beginning of endocarditis.
    Stroke 12 March 2005.
    Endocarditis diagnosed 16 March 2005.
    MVR/AVR - ATS 30 June 2005.
    Discharged 10 July 2005, taken ill on journey from hospital.
    Admitted to hospital 14 July 2005, complete heart block.
    Discharged from hospital 22 July 2005.
    Returned to work 9am on 7 November, dismissed 9am 7 November 2005.

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    Quote Originally Posted by bbb View Post
    Good site about prosthetic heart valves:

    http://emedicine.medscape.com/article/780702-overview

    Sounds like, if I am interpreting this right, there is not a huge risk of endocarditis for people with prosthetic heart valves:

    PVE (Prosthetic Valve Endocarditis) occurs in 2-4% of patients. The incidence is 3% in the first postoperative year, then 0.5% for subsequent years. The incidence is higher in mitral valves. Mechanical and biological valves are equally susceptible.
    Yes and it answers some questions by listing the most common causes
    of prosthetic valve endocarditis - such as;1)dental procedures, 2)Genito-
    Urinary sources(I guess kidney/bladder infections), 3) G.I manipulation-
    (maybe endoscopy), 4)I.V. drug abuse- but I have to wonder if this includes
    anything given intravenously where sterile procedure is not followed(?).

    Just some thoughts.
    Thanks for the Info - Dina
    Tricuspid Valve Replacement(Bovine)2/4/08
    A.Flutter x 3,with 2 ablations & cardioversion 2007
    "A little learning is a dangerous thing..."-by Alexander Pope

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