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Critical Care Management of the ACHD Patient with Endocarditis

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Intensive Care of the Adult with Congenital Heart Disease

Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

Abstract

Infective endocarditis (IE) in adult congenital heart disease (ACHD) patients is a crucial issue. The risk of endocarditis is much higher in ACHD patients than in the general population (1.3 cases/10,000 person-years vs. 3–7 per 100,000 person-years, respectively). Nevertheless, compared to non-congenital population, its outcome is usually seen as less severe. Independent predictors of IE in this specific population are baseline valve-containing prosthetics, multiple defects, previous IE, and gender (lower incidence in females). As we focus on critical care on this review, every step of management from diagnosis to medical or surgical treatment can be different from the usual strategies addressed to non-ACHD patients admitted with endocarditis. The incidence of right-sided endocarditis is preeminent in this population and can explain the global lower mortality in these patients (still up to 16%).

Endocarditis in ACHD carries a significant risk of deterioration, either in left heart disease with the risk of neurologic complications or in obstructive forms of pulmonary endocarditis which can be rapidly life threatening on a previously stable patient.

Transesophageal echocardiography, viewed as the gold standard diagnostic tool in non-congenital patients, can be misleading especially in cyanotic disease and in right heart endocarditis. CT scanner is therefore becoming a useful tool in the diagnosis of endocarditis for ACHD patients. Timing of surgery, if necessary, is difficult to define, in multi-operated patients with comorbidities. Postoperative course is threatened by renal or heart failure. For all these reasons, international guidelines recommend a specialized team approach to comprehensively manage IE in ACHD patients, especially when complex and/or with multi-organ involvement.

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Author information

Authors and Affiliations

  1. ACHD Unit, Cardiology Department and M3C center of reference for complex congenital defects, Hôpital Européen Georges Pompidou, Paris, France

    Laurence Iserin

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  1. Laurence Iserin
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Correspondence to Laurence Iserin .

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Editors and Affiliations

  1. Children’s Hospital Colorado, University of Colorado Denver, Aurora, CO, USA

    Eduardo da Cruz

  2. Pediatric Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK

    Duncan Macrae

  3. Adult Congenital Heart Program, Heart Institute, Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA

    Gary Webb

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Iserin, L. (2019). Critical Care Management of the ACHD Patient with Endocarditis. In: da Cruz, E., Macrae, D., Webb, G. (eds) Intensive Care of the Adult with Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-94171-4_17

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  • DOI: https://doi.org/10.1007/978-3-319-94171-4_17

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