Letters to the Editor - July 1, 2001 - American Family Physician

Letters to the Editor

Management of MVP with Antibiotic Prophylaxis

TO THE EDITOR: In the article on management of mitral valve prolapse (MVP),¹ the authors state that antibiotic prophylaxis is "recommended for most patients with definite diagnosis of mitral valve prolapse," but do not lay out specific criteria for this. I wish to clarify this point.

The authors refer to the guidelines regarding valvular heart disease that were published in 1998.² These guidelines reaffirm that a prophylactic antibiotic should be given to patients with MVP characterized by a systolic click and accompanying systolic murmur, as well as those with documented echocardiographic evidence of concomitant MVP and mitral regurgitation. Whether a prophylactic antibiotic should be given in the absence of a systolic murmur has been a matter of some debate. The American College of Cardiology/ American Heart Association guidelines state:

There has been some disagreement concerning whether patients with an isolated systolic click and no systolic murmur should undergo endocarditis prophylaxis. Patients with only a systolic click who have echocardiographic evidence of a higher-risk profile for endocarditis, such as leaflet thickening, elongated chordae, left atrial enlargement, or LV dilatation, should receive endocarditis prophylaxis.²

These recommendations are summarized in the accompanying table. As in the past, antibiotic prophylaxis is not recommended for patients with an isolated systolic click and no distinct echocardiographic evidence of MVP.

TABLE
Recommendations for Antibiotic Endocarditis Prophylaxis for Patients with MVP Undergoing Procedures Associated with Bacteremia*

Patients with characteristic systolic click-murmur complex

Patients with isolated systolic click and echocardiographic evidence of MVP and MR

Patients with isolated systolic click, echocardiographic evidence of high-risk MVP

Patients with isolated systolic click and equivocal or no evidence of MVP

MVP = mitral valve prolapse; MR = mitral regurgitation.

*--These procedures are defined in the American Heart Association guidelines for prevention of endocarditis and in the full-text version of these guidelines.

Adapted with permission from ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998;32:1986-8.

BARRY D. WEISS, M.D.
Department of Family and Community Medicine
University of Arizona College of Medicine
Tucson, AZ 85719

REFERENCES

Bouknight DP, O' Rourke RA. Current management of mitral valve prolapse. Am Fam Physician 2000; 61:3343-50,3353-4.

ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines. J Am Coll Cardiol 1998;32:1486-588.

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Corrections*

An item in "Tips from Other Journals," entitled "Diagnosis and Management of Nonalcoholic Steatohepatitis" (January 1, 2001, page 133), contained an error in the fourth paragraph on page 133. The third sentence, which reads "Patients should be advised to be immunized against hepatitis C and hepatitis B," should have been omitted. There is no immunization available for hepatitis C, and the original article did not recommend immunization for hepatitis B.

The article "Alternative Therapies: Part II. Congestive Heart Failure and Hypercholesterolemia" (September 15, 2000, page 1325) contained an error in the second sentence of the first full paragraph in the right-hand column on page 1328. The correct sentence reads as follows: "This 'red rice yeast product' has been used for centuries in China and contains starch, protein, fiber and at least eight statin compounds, which function as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors." The abbreviation was also incorrectly expanded in Table 1.

*These corrections have been made to the online version of AFP. The links above will take you to the corrected items, which remain part of the online issues in which they were originally published.

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