A patient has mitral valve PROLAPSE and a documented history of PREVIOUS INFECTIVE ENDOCARDITIS. What is the correct approach before an extraction?

Correct answer: C. Antibiotic prophylaxis is indicated

• A. The premise is correct but the conclusion is wrong. Mitral valve prolapse — even with regurgitation — has NOT been an indication since 2007. But the second element of this history overrides that.
• B. The presence or absence of a murmur does not determine prophylaxis; the qualifying cardiac condition does.
• C. CORRECT. PROPHYLAXIS IS INDICATED — not because of the mitral valve prolapse, but because of the PREVIOUS INFECTIVE ENDOCARDITIS. A prior episode is one of the small number of conditions the AHA retains, since it identifies a patient at the highest risk of an adverse outcome should endocarditis recur.
• D. The 2007 revision narrowed the indications dramatically; it did not abolish prophylaxis. Four categories remain.

Note: The four AHA categories: (1) prosthetic heart valve or prosthetic material used for valve repair, including transcatheter valves; (2) PREVIOUS INFECTIVE ENDOCARDITIS; (3) specified congenital heart disease — unrepaired cyanotic CHD, repaired CHD with prosthetic material within the first 6 months, or repaired CHD with a residual defect at or adjacent to the prosthetic site; (4) cardiac transplant recipients who develop valvulopathy. Regimen: amoxicillin 2 g orally 30–60 minutes before the procedure.