A. Heart failure
B. Unctrontrolled infection
C. Prevention of embolism
A. HEART FAILURE:
PVE with severe prosthetic dysfunction (dehiscence or obstruction) causing refractory pulmonary oedema or cardiogenic shock. |
| Timing |
Class |
Level |
| Emergency |
I |
B |
| A. PVE with fistula into a cardiac chamber or pericardium causing refractory pulmonary oedema or cardiogenic shock. |
| Timing |
Class |
Level |
| Emergency |
I |
B |
| A. PVE with severe prosthetic dysfunction and persisting heart failure. |
| Timing |
Class |
Level |
| Urgent |
I |
B |
| A. Severe prosthetic dehiscence without heart failure. |
| Timing |
Class |
Level |
| Elective |
I |
B |
B. UNCTRONTROLLED INFECTION:
Locally uncontrolled infection (abscess, false aneurysm, enlarging vegetation). |
| Timing |
Class |
Level |
| Urgent |
I |
B |
| B. PVE caused by fungi or multiresistant organisms. |
| Timing |
Class |
Level |
| Urgent/ elective |
I |
B |
| B. PVE with persisting fever and positive blood culture > 7-10 days. |
| Timing |
Class |
Level |
| Urgent |
I |
B |
| B. PVE caused by staphylocci or gram negative bacteria: (most cases of early PVE). |
| Timing |
Class |
Level |
| Urgent/ elective |
I |
C |
C. PREVENTION OF EMBOLISM:
PVE with recurrent emboli despite appropriate treatment. |
| Timing |
Class |
Level |
| Urgent |
I |
B |
| C. PVE with large vegetations (10 mm) and other predictors of complicated course (HF, persistent infection, abscess). |
| Timing |
Class |
Level |
| Urgent |
I |
B |
| C. PVE with isolated very large vegetations (> 15 mm). |
| Timing |
Class |
Level |
| Urgent |
IIb |
C |