A 52 year old woman is scheduled to undergo double valve replacement surgery for severe mitral stenosis and severe aortic regurgitation. She has no other comorbidities. As part of the routine preoperative evaluation a dental consultation is obtained. She is found to have dental caries in one premolar and the dentist advises extraction of the tooth. Would you advise periprocedural infective endocarditis prophylaxis?
A 44 year old manual labourer from a village in a developing country presented with progressive dyspnea on exertion of two years duration. Two months before presentation, he had stopped going to work because of his dyspnea. He was diagnosed to have a calcific mitral valve with severe stenosis (mitral valve area 0.8 cm2) and mild regurgitation. He had moderate pulmonary artery hypertension. His aortic and tricuspid valves were normal. He had no coronary artery disease and was in sinus rhythm. He was referred for valve replacement surgery. Should this patient receive a mechanical or a tissue valve?
Welcome to the new Heart Asia blog.
Often, the management of patients in developing countries differs in important ways from that recommended in western guidelines. Strong beliefs and perceptions, about differences in patient characteristics and response to treatment, lead well‐intentioned local practitioners to “stray” from guideline‐recommended practice. A series of interactive clinical cases that we will be publishing periodically on this blog seeks to objectively explore these variations in clinical practice. Differing management approaches will be presented for each clinical scenario by expert clinicians. Readers will be encouraged to indicate their preferences by voting and commenting. A more detailed exposition of these points of view will follow as debate articles in the Journal.
Many thanks to the authors of the first case for presenting their carefully considered approaches. I look forward to receiving your votes and comments and hope that you will find these cases useful. If you have any suggestions for suitable future cases, please contact me.