European Journal of Pediatrics

, 170:1111 | Cite as

Infective endocarditis in congenital heart disease

  • Walter KnirschEmail author
  • David Nadal


Congenital heart disease (CHD) has become the leading risk factor for pediatric infective endocarditis (IE) in developed countries after the decline of rheumatic heart disease. Advances in catheter- and surgery-based cardiac interventions have rendered almost all types of CHD amenable to complete correction or at least palliation. Patient survival has increased, and a new patient population, referred to as adult CHD (ACHD) patients, has emerged. Implanted prosthetic material paves the way for cardiovascular device-related infections, but studies on the management of CHD-associated IE in the era of cardiovascular devices are scarce. The types of heart malformation (unrepaired, repaired, palliated) substantially differ in their lifetime risks for IE. Streptococci and staphylococci are the predominant pathogens. Right-sided IE is more frequently seen in patients with CHD. Relevant comorbidity caused by cardiac and extracardiac episode-related complications is high. Transesophageal echocardiography is recommended for more precise visualization of vegetations, especially in complex type of CHD in ACHD patients. Antimicrobial therapy and surgical management of IE remain challenging, but outcome of CHD-associated IE from the neonate to the adult is better than in other forms of IE. Conclusion: Primary prevention of IE is vital and includes good dental health and skin hygiene; antibiotic prophylaxis is indicated only in high-risk patients undergoing oral mucosal procedures.


Infective endocarditis Congenital heart disease Cardiac surgery Interventional cardiology Echocardiography Blood culture 



Adult with congenital heart disease


American Heart Association


Atrial septal defect


Atrial septal defect occlusion system


Aortic valve


Congenital heart disease


Congestive heart failure


Confidence interval


Coarctation of the aortic arch


European Society of Cardiology


Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae


Hypoplastic left heart syndrome


Infective endocarditis


Intravenous drug abuser


Left atrium


Left pulmonary artery


Left ventricle


Mitral valve


Nonbacterial thrombotic endocarditis


No data


Pulmonary artery


Patent ductus arteriosus


Patent foramen ovale


Pulmonary valve stenosis


Pulmonary valve


Perivalvular abscess


Right atrium


Rheumatic heart disease


Right ventricle


Subaortic stenosis

3rd gen

3rd generation


Transesophageal echocardiography


Transthoracic ecocardiography


Tricuspid valve


Ventricular septal defect



We would like to thank Dr. A. Dodge-Khatami for his assistance in gathering data on surgery-based devices and Susanne Staubli for her assistance in creating figures.


DN has received research and travel grants from AstraZeneca, Abbott, and Pfizer but has no conflict of interest with this work.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Division of Pediatric CardiologyUniversity Children’s Hospital ZurichZurichSwitzerland
  2. 2.Division of Infectious Diseases and Hospital EpidemiologyUniversity Children’s Hospital ZurichZurichSwitzerland
  3. 3.Children’s Research CenterUniversity Children’s Hospital ZurichZurichSwitzerland

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