Mitral Valve Prolapse and surgery

  I was diagnosed with MVP about 13 yrs back and over time when had major invasive surgery I had to take antibiotics before (11 yrs back) and over time for some dental work too.  I understand protocols have changed and I read a lot about not requiring antibiotic before dental work but not much about surgery.  I have a surgery next month for my ankle.  Seems have some torn ligaments and maybe some chipped bone (but wont know for sure until they go in I suppose as MRI supposedly doesn't tell everything#.  Am I supposed to get cardiac testing done and do I need antibiotics before surgery?  Please advise.  I don't think I have significant MVP issues.  My original diagnosis 13 yrs back was MVP with slight reguiration??? I think.  Over time when docs find out and do echo etc, no one mentions anything much so I am not sure if I even have the slight reguiration #sp).  Thanks for your help.

Hi P,

I agree you with that the Mitral Valve Prolapse (MVP) is probably not a serious condition in your case. Antibiotic prophylaxis is used to prevent an infection inside the heart (called Infective endocarditis) of susceptible patients. As an example, even a minor infection, such as a tooth abscess can cause severe bacterial endocarditis. However, recent recommendations for prophylactic antibiotic therapy before a procedure  in patients with mitral valve and other cardiac diseases have changed and now include:
  • Infective endocarditis is more likely to result from exposure to random bacterial infections associated with daily activities than caused by dental, GI tract, or GU (Read: no orthopedic) procedures. 
Re: Evaluation and Management of the Asymptomatic Patient With Mitral Valve Prolapse (your situation):
  • Antibiotic prophylaxis is no longer indicated in all patients with MVP for prevention of infective endocarditis.
I doubt your condition is an exception.
Hope this helps,
Dr T



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