Care after procedures, and Frequently Asked Questions
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Following procedure, individualized advice will be provided.
Below are several aspects, which may be discussed, depending on type of procedure.
Endocarditis prophylaxis
Some patients may be at increased risk of infection of heart, called endocarditis. Risk of endocarditis may be increased either only for 6 months after procedure, or lifelong, depending on underlying condition, patient's medical history, and type of procedure.
As endocarditis is a serious condition, prevention is very important. Meticulous dental and skin hygiene are very important, because bacteria may enter bloodstream through mouth or skin. Skin or mucous membrane injuries, including piercing, and tattoos, should be avoided.
Certain medical procedures, are associated with increased risk of bacteria leaking to bloodstream and therefore increased risk of endocarditis. According to the European Society of Cardiology, risk is particularly increased with invasive dental procedures. Therefore, single does of antibiotics may be required, 30-60min before dental procedure. European Society of Cardiology (Eur Heart J. 2015 Aug 29. pii: ehv319, Table 6), advises in this case amoxicillin or ampicillin 2g po or IV 30-60min prior to the dental procedure. If allergic to penicillin or ampicillin, clindamycin 600mg po/iv should be used in adults.
Antibiotic endocarditis prophylaxis is advised in most patients after percutaneous closure of Atrial Septal Defect, PFO, VSD, within first six months after closure. In some patients, it may be required beyond 6 months after closure.
After percutaneous valve replacement, lifelong antibiotic endocarditis prophylaxis is advised in most patients.
MRI after implantation of metal device, including stents, valves, and occluders
Presence of any implants, needs to be disclosed to the doctor referring for Magnetic Resonance Imaging (MRI) and to the team performing the MRI scan. Magnetic field within the MRI scanner and in its proximity is very strong, and implants may react with the field in various ways. The interaction of implant with magnetic field may include heating of implant, displacement of implant and artifact around the implant.
There are online resources providing information regarding MRI safety for specific implants.
It is important for patient to provide implantation date and type of implant to the doctor referring for MRI and the team performing MRI scan, so that they judge if performing MRI is appropriate and safe.