[Infection sources in HNO- and jawbone regions in patients before valve replacement surgery]

Prosthetic valve endocarditis is a life-threatening complication after valve replacement surgery. Therefore, it is common to perform a screening for potential sources of infection before surgery in order to be able to do a prophylactic treatment.

The incidence of potential infectious sources of bacteremia in the dental, jaw and nasopharyngeal area was evaluated in 92 patients going to have valve replacement surgery. Screening examinations were an X-ray of the paranasal sinuses and a panoramic radiograph of the dental arch. Chronic apical periodontitis, cysts and remaining radices were counted as dental sources. Each shadow in the paranasal sinuses X-ray was seen as pathological and was further investigated by an otorhinolaryngologist.

A potential infectious source was found in 49 patients. 42 patients had a dental infectious source with need for treatment. 19 patients showed a pathologic sinus X-ray (three aspergillomas, three sinusitis, the others had a chronic polyposis with no need for treatment). Twelve patients had dental as well as sinusoidal sources. Erythrocyte sedimentation rate did not refer to the appearance of infectious sources. Patients going to have a mitral valve replacement had most dental sources (61%), 47% of the patients with planned aortic valve replacement, 50% of the patients planned to get more than one heart valve replaced, 50% of the patients getting mitral valve replacement and CABG and 40% of the patients waiting for aortic valve replacement and CABG had dental foci.

Screening for infectious foci before valve replacement surgery diagnosed foci in a high percentage of the patients. Nevertheless current data concerning whether a prophylactic treatment may reduce the incidence of prosthetic valve endocarditis are conflicting.