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Endocarditis
Prophylaxis Recommended
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-
High-Risk
Category
-
Prosthetic
cardiac valves, including bioprosthetic and homograft valves
-
Previous
bacterial endocarditis
-
Complex
cyanotic congenital heart disease (eg, single ventricle
states, transposition of the great arteries, tetralogy of
Fallot)
-
Surgically
constructed systemic-pulmonary shunts or conduits
- Moderate-Risk
Category
- Congenital
cardiac malformations other than those listed in the high-risk
and negligible-risk categories
- Acquired
valvular dysfunction (eg, rheumatic heart disease)
- Hypertrophic
cardiomyopathy
- Mitral
valve prolapse with valvular regurgitation and/or thickened
leaflets1
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Endocarditis
Prophylaxis Not Recommended
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- Negligible-risk
category (no greater risk than the general population)
- Isolated
secundum atrial septal defect
- Surgical
repair of atrial septal defect, ventricular septal defect
or patent ductus arteriosus (without residua beyond six months)
- Previous
coronary artery bypass graft surgery
- Mitral
valve prolapse without valvular regurgitation or thickened
leaflets1
- Physiologic,
functional or innocent heart murmur
- Previous
Kawasaki disease without valvular dysfunction
- Previous
rheumatic fever without valvular dysfunction
- Cardiac
pacemakers (intravascular and epicardial) and implanted defibrillators
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1. Some experts feel
that the presence of an audible nonejection click even without a murmur
warrants prophylaxis. A detailed discussion is found in reference 1.
Adapted from Dajani
AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis.
Recommendations by the American Heart Association. JAMA. 1997; 277:1794-1801.
Copyrighted 1997, American Medical Association.
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