It is true that the usual treatment for endocarditis is a regimen of IV antibiotics, typically for 4-6 weeks (although the infection is usually eradicated after 2 weeks of treatment). The infection can damage or destroy a heart valve, and it is not uncommon that a patient will need valve repair or replacement surgery as a result. Sometimes the damage to the valve is so severe that the operation must be performed before the infection is treated, and this was apparently House’s idea when he suggested removing the infected valve to cure the infection. The problem with this idea is that the operation treats the heart illness, not the infection. To be sure, eliminating the bacterial vegetation from the heart will go a long way toward treating the infection, but it cannot eliminate it — chances are that the bacteria will still be in the bloodstream somewhere. House is board certified in infective disease and should know better.

Even if House’s idea were medically sound, it would not require removal of the valve. Unless the valve was damaged, the bacterial growth could be removed while leaving the valve in place. Even if the valve were damaged, the usual procedure would be to repair, not replace it (thereby avoiding coumadin therapy for life). If the valve was damaged to the point that it could not be repaired, chances are it would have been picked up during the examination of the boy (the murmur and regurgitation would have been detected by auscultation). As pointed out by at least one other commenter, an animal valve does not require the coumadin treatment, but they wear out and given the boy’s age, it is almost certain that they would have given him an artificial valve.

The shot of the surgery showed the operation being performed through the sternum. These days, the surgery can often be performed by a minimally invasive technique, often with the use of a robotic device. It would be unusual for a leading hospital (such as PPH is supposed to be) not to be using the more up to date and preferred procedure. Had the boy’s sternum been opened up, he would have been in intensive care for at least two days and in very rough shape for a while afterwards. His condition was unrealistically good when Foreman was sticking needles in him, but patients on this show typically recover miraculously from major procedures.

To respond to Yok’s comment about empiric antibiotics, a significant percentage of endocarditis cases cannot be cultured and empirical treatment is the only way to go.

Foreman brings the mood down too well compared to when the others aren’t happy.

av

One of the worst things a show can do is STAY THE SAME. Characters need to change as a result of what happens to them. If they don’t, it gets boring.

But obviously because it was about a brother trying to donate bone marrow to his brother who has cancer, it must have been ripped off from that book. Oh yes. That’s clearly a very keen observation, and not just a stupid thing to say.

Many websites say that peripheral blood is used for transplants nowadays rather than actual marrow. I’ve read that removing the marrow from the hip is considered a ‘traditional’ process. Apparently, after several injections of filgrastim, the donor can undergo aphaeresis to remove the blood stem cells directly from their blood. Is this true, and if so, how often do they perform transplants using this method? Why has it not been brought up? Would it not have worked for the two brothers in this episode?