Endocarditis and valve selection

[start01]

Having caught endocarditis twice within 12 months, surgery to repair or replace my mitral valve is on the cards.

My question is (assuming a repair is out of the question) - which type of valve either mechanical or tissue has a lower risk of one getting endocarditis (again)? I am aware there are other factors such as oral hygene, but all things being equal what would be the way to go?

Regarding the risks of surgery (age, general health, other medical conditions, and heart function) I am an active 36 year old. Before my first stint with Endocarditis I had never spent a night in hospital (apart from when my wife gave birth).

I would be interested in getting your view points and would be grateful if you could share your experiences.

 

[Agian]

What was the reason you got endocarditis? Is it valve related? People with bicuspid and other heart problems are more at risk. I'm only asking because the cause may be reversible. Having said that, anyone with a prosthetic valve is at increased risk. The surgeon I saw told me that tissue valves are less prone to endocarditis. I can't say I'm 100% convinced, either way.

 

[OldManEmu]

Again once you have had endocarditis once you are at increased risk of re-infection of endocarditis regardless of native or prosthetic valve.
I was also advised that tissue valves, once healing was complete from surgery were less prone to endocarditis infection.
Homograph tissue valves tend to be the preferred valve when surgery is performed on patients with active endocarditis.

http://www.ctsnet.org/doc/101

 

[Agian]

It seems that it can theoretically affect anyone.

 

[VegasBAV]

I'm not a doctor, but I had endocarditis and then did some research about it, and it suggested that tissue and mechanical valves have essentially the same odds of getting it again.

 

[start01]

thanks for all your input.

@Agian - I was not given a reason why i first contracted endocarditis. With no history of heart issues it came as a total surprise, and it took the docs a few weeks to diagnose what I had as I had no previous history regarding my heart.

 

[Gail in Ca]

My infectious disease doc never mentioned that one valve is putting me at higher risk than another, neither did my surgeon mention it.
He would've given me homograph if the aorta couldn't accept another mechanical. But, I ended up with mechanical inside a graft and mitral repair.
All is well 4 1/2 yrs later.
I wonder if your bacteria was never fully gotten rid of. Was it the same bacteria the 2nd time you got endocarditis in a year?

 

[heartstream]

That's a good point Gail mentioned. To get it twice in a year is unusual if not very unlucky.

When I had it years ago I was in hospital for three months on iv antibiotics then I had 6 month worth of oral to make sure it was clear.

 

[start01]

Hi Gail

The first time I got endocarditis I was given antibiotics before I was diagnosed the first time round, so my bloods came up clear (the vampire nurses still took blood 3 times a day - second time round the bacteria has been diagnosed. Have spoken to the microbiologist and they say it is unlikely it was the same bacteria as I did have bloods taken in between the 2 occurrences.

My infectious disease doc never mentioned that one valve is putting me at higher risk than another, neither did my surgeon mention it.
He would've given me homograph if the aorta couldn't accept another mechanical. But, I ended up with mechanical inside a graft and mitral repair.
All is well 4 1/2 yrs later.
I wonder if your bacteria was never fully gotten rid of. Was it the same bacteria the 2nd time you got endocarditis in a year?

 

[OldManEmu]

Start

The first time I got endocarditis I was given antibiotics before I was diagnosed the first time round, so my bloods came up ..

This is the exact reason the infectious diseases specialist said to me endocarditis is often not diagnosed correctly. Blood cultures should be taken several days apart while the patient isn't on antibiotics so the progression and identification of the infection can be correctly identified. Oral antibiotics are very good at killing the infection outside the heart and therefore not showing up in blood tests, however the infection remains in the heart only to re-emerge once the antibiotics are discontinued, this is why it took 9 months for my endocarditis to be correctly diagnosed.

 

[Onx_06]

Hi Start01,
What did you end up doing? I have a mechanical aortic valve and just recently had enterococcus (very rare) that lead to Endocarditis .. I am not even sure if it is Endocarditis because heart functions / valves looks fine on echo .. once a TEE or TOE was done - the cardiologist saw a very tiny (.5mm-1cm) on the mechanical valve leaflet .. no root involvement etc .. I am stumped on what will be the PLAN to get this diagnosed correctly.
Please share any update that you have on your side. Thanks.