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European Journal of Pediatrics

, 170:1111 | Cite as

Infective endocarditis in congenital heart disease

  • Walter KnirschEmail author
  • David Nadal
Review

Abstract

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.

Keywords

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

Abbreviations

ACHD

Adult with congenital heart disease

AHA

American Heart Association

ASD

Atrial septal defect

ASDOS

Atrial septal defect occlusion system

AV

Aortic valve

CHD

Congenital heart disease

CHF

Congestive heart failure

CI

Confidence interval

CoA

Coarctation of the aortic arch

ESC

European Society of Cardiology

HACEK

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

HLHS

Hypoplastic left heart syndrome

IE

Infective endocarditis

IVDA

Intravenous drug abuser

LA

Left atrium

LPA

Left pulmonary artery

LV

Left ventricle

MV

Mitral valve

NBTE

Nonbacterial thrombotic endocarditis

n.d.

No data

PA

Pulmonary artery

PDA

Patent ductus arteriosus

PFO

Patent foramen ovale

Pst

Pulmonary valve stenosis

PV

Pulmonary valve

PVA

Perivalvular abscess

RA

Right atrium

RHD

Rheumatic heart disease

RV

Right ventricle

SAS

Subaortic stenosis

3rd gen

3rd generation

TEE

Transesophageal echocardiography

TTE

Transthoracic ecocardiography

TV

Tricuspid valve

VSD

Ventricular septal defect

Notes

Acknowledgments

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.

Disclosures

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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