Which procedure requires infective endocarditis prophylaxis in a patient with a mechanical mitral valve?

Infective endocarditis prophylaxis is essential for patients with certain high-risk heart conditions, including those who have mechanical heart valves, such as a mechanical mitral valve. The rationale behind this is that procedures that may lead to a transient bacteremia can pose a significant risk for these patients, potentially leading to infective endocarditis.

Among the listed procedures, the removal of an infected renal calculus is the one that would typically require this prophylaxis. This procedure involves manipulating structures that can introduce bacteria into the bloodstream, creating a higher risk for patients with a mechanical mitral valve to develop an infection in the heart.

Routine dental cleaning, screening colonoscopy, and elective plastic surgery are generally considered lower risk procedures for inducing bacteremia compared to more invasive surgical interventions, including those that involve the urogenital tract or procedures that account for a greater degree of tissue trauma. Currently, guidelines focus endocarditis prophylaxis primarily on situations and procedures where the risk for bacteremia is significantly elevated, which is the case with the removal of an infected renal calculus, as it involves invasive surgical intervention.

Thus, the necessity for endocarditis prophylaxis aligns with the increased risk of infection based on the nature of the procedure and the specific cardiac condition of the patient