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Internal Medicine

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Which one of the following patients should receive antibiotic prophylaxis to prevent infective endocarditis prior to having dental work that will include periodontal manipulation?

A) A 6-year-old male with an unrepaired atrial septal defect

B) A 32-year-old female with mitral valve prolapse with significant regurgitation

C) A 52-year-old male with a past history of a transcatheter aortic valve replacement

D) A 60-year-old male with atrial fibrillation due to rheumatic mitral valve disease

E) A 70-year-old female with hemodynamically significant aortic stenosis/aortic insufficiency

Ayham Alagha
D B T

ANSWER: C

Of the patients listed, only the patient with a transcatheter-implanted aortic valve is at increased risk of infective endocarditis (IE) associated with dental procedures.

Any patient with a history of valve repair or replacement that involves prosthetic material is at increased risk for IE, but even those with significant valvular disease do not benefit from prophylaxis.

Certain patients with congenital heart disease should also receive prophylaxis, but an isolated atrial septal defect is not associated with an increased risk of IE after dental procedures.


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