According to current guidelines, antibiotic prophylaxis against infective endocarditis is indicated BEFORE dental procedures in which of the following patients?

• A Unrepaired cyanotic congenital heart disease with an operative palliative shunt ✓
• B Secundum atrial septal defect closed by device 3 years ago with no residual shunt
• C Small muscular ventricular septal defect with no haemodynamic significance
• D Mild valvar pulmonary stenosis with peak gradient of 25 mmHg

Explanation

Current AHA guidelines limit prophylaxis to cardiac conditions with the highest risk: unrepaired cyanotic congenital heart disease including palliative shunts and conduits, prosthetic valves, previous infective endocarditis, and repaired defects with prosthetic material within six months of the procedure. Device-closed ASD beyond six months, small restrictive VSD, and mild pulmonary stenosis carry negligible endocarditis risk and do not require prophylaxis under these guidelines.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.