Advertisement

Critical Care Management of the ACHD Patient with Endocarditis

  • Laurence Iserin
Chapter
Part of the Congenital Heart Disease in Adolescents and Adults book series (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.

Keywords

Endocarditis Congenital heart disease Cardiac imaging Valve disease Echocardiography Prognosis Guidelines Infection Nuclear imaging Congenital cardiac surgery Cardiac device Prosthetic heart valves Prophylaxis 

References

  1. 1.
    Mirabel M, Sonneville R, Hajage D, Novy E, Tubach F, Vignon P, Perez P, Lavoué S, Kouatchet A, Pajot O, Mekontso-Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Timsit JF, Megarbane B, Wolff M, Trouillet JL, ENDOREA Study Group. Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J. 2014;35(18):1195–204.CrossRefGoogle Scholar
  2. 2.
    Price S, Jaggar SI, Jordan S, et al. Adult congenital heart disease: intensive care management and outcome prediction. Intensive Care Med. 2007;33:652–9.CrossRefGoogle Scholar
  3. 3.
    Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2015;36(44):3075–128.CrossRefGoogle Scholar
  4. 4.
    Cedars A, Benjamin L, Burns SV, Novak E, Amin A. Clinical predictors of length of stay in adults with congenital heart disease. Heart. 2017;103(16):1258–63.CrossRefGoogle Scholar
  5. 5.
    Verheugt CL, Uiterwaal CS, van der Velde ET, Meijboom FJ, Pieper PG, Veen G, Stappers JL, Grobbee DE, Mulder BJ. Turning 18 with congenital heart disease: prediction of infective endocarditis based on a large population. Eur Heart J. 2011;32:1926–34.CrossRefGoogle Scholar
  6. 6.
    Mourvillier B, Trouillet JL, Timsit JF, et al. Infective endocarditis in the intensive care unit. Clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med. 2004;30:2046–52.CrossRefGoogle Scholar
  7. 7.
    Tutarel O, Alonso-Gonzalez R, Montanaro C, Schiff R, Uribarri A, Kempny A, Grübler MR, Uebing A, Swan L, Diller GP, Dimopoulos K, Gatzoulis MA. Infective endocarditis in adults with congenital heart disease remains a lethal disease. Heart. 2018;104:161–5.CrossRefGoogle Scholar
  8. 8.
    Li W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J. 1998;19:166–73.CrossRefGoogle Scholar
  9. 9.
    Kuijpers JM, Koolbergen DR, Groenink M, Peels KCH, Reichert CLA, Post MC, Bosker HA, Wajon EMCJ, Zwinderman AH, Mulder BJM, Bouma BJ. Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: focus on the use of prosthetic material. Eur Heart J. 2017;38(26):2048–56.PubMedGoogle Scholar
  10. 10.
    Marelli AS, Mackie R, Ionescu-Ittu E, Rahme L. Pilote: congenital heart disease in the general population: changing prevalence and age distribution. Circulation. 2007;115(2):163–72.CrossRefGoogle Scholar
  11. 11.
    Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA. 1998;279:599–603.CrossRefGoogle Scholar
  12. 12.
    Ishiwada N, Niwa K, Tateno S, et al. Causative organism influences clinical profile and outcome of infective endocarditis in pediatric patients and adults with congenital heart disease. Circ J. 2005;69:1266–7.CrossRefGoogle Scholar
  13. 13.
    Baek JE, Park SJ, Woo SB, Choi JY, Jung JW, Kim NK. Changes in patient characteristics of infective endocarditis with congenital heart disease: 25 years experience in a single institution. Korean Circ J. 2014;44:37–41.CrossRefGoogle Scholar
  14. 14.
    Morsheimer M, Brown Whitehorn TF, Heimall J, Sullivan KE. The immune deficiency of chromosome 22q11.2 deletion syndrome. Am J Med Genet A. 2017;173(9):2366–72.CrossRefGoogle Scholar
  15. 15.
    Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132:1435–86.CrossRefGoogle Scholar
  16. 16.
    Tubiana S, Blotière PO, Hoen B, Lesclous P, Millot S, Rudant J, Weill A, Coste J, Alla F, Duval X. Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study. BMJ. 2017;358:j3776.CrossRefGoogle Scholar
  17. 17.
    Thornhill MH, Dayer M, Lockhart PB, McGurk M, Shanson D, Prendergast B, Chambers JB. A change in the NICE guidelines on antibiotic prophylaxis. Br Dent J. 2016;221(3):112–4.CrossRefGoogle Scholar
  18. 18.
    Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224:59–74.CrossRefGoogle Scholar
  19. 19.
    Sandoe JA, Barlow GV, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint working party project on behalf of the British Society of Antimicrobial Chemotherapy, British Heart Rhythm Society, British Cardiovascular Society, British Heart Valve Society, and British Society of Echocardiography. J Antimicrob Chemother. 2015;70(2):325–59.CrossRefGoogle Scholar
  20. 20.
    Verheugt CL, Uiterwaal CS, Vaartjes I, van der Velde ET, Zomer AC, Meijboom FJ, Pieper PG, Post MC, Vliegen HW, Hazekamp MG, Grobbee DE, Mulder BJ. Chance of surgery in adult congenital heart disease. Eur J Prev Cardiol. 2017;24(12):1319–27.CrossRefGoogle Scholar
  21. 21.
    Jalal Z, Galmiche L, Lebeaux D, Villemain O, Brugada G, et al. Selective propensity of bovine jugular vein material to bacterial adhesions: an in-vitro study. Int J Cardiol. 2015;198:201–5.CrossRefGoogle Scholar
  22. 22.
    Malekzadeh-Milani S, Ladouceur M, Iserin L, Bonnet D, Boudjemline Y. Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation. J Thorac Cardiovasc Surg. 2014;148(5):2253–9.CrossRefGoogle Scholar
  23. 23.
    Malekzadeh-Milani S, Ladouceur M, Patel M, Boughenou FM, Iserin L, Bonnet D, Boudjemline Y. Incidence and predictors of Melody® valve endocarditis: a prospective study. Arch Cardiovasc Dis. 2015;108(2):97–106.CrossRefGoogle Scholar
  24. 24.
    Sharma A, Cote AT, Hosking MCK, Harris KC. A systematic review of infective endocarditis in patients with bovine jugular vein valves compared with other valve types. JACC Cardiovasc Interv. 2017;10(14):1449–58.CrossRefGoogle Scholar
  25. 25.
    Yu CH, Minnema BJ, Gold WL. Bacterial infections complicating tongue piercing. Can J Infect Dis Med Microbiol. 2010;21:e70–4.CrossRefGoogle Scholar
  26. 26.
    Gatzoulis. Adult congenital heart disease: education, education, education. Nat Clin Pract Cardiovasc Med. 2006;3(1):2–3.CrossRefGoogle Scholar
  27. 27.
    Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Core GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–8.CrossRefGoogle Scholar
  28. 28.
    Pizzi MN, Dos-Subirà L, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Pijuan Domènech A, Gonzàlez-Alujas MT, Subirana-Domènech MT, Miranda-Barrio B, Ferreira-González I, González-López JJ, Igual A, Maisterra-Santos O, García-Dorado D, Castell-Conesa J, Almirante B, Escobar Amores M, Tornos P, Aguadé-Bruix S. (18)F-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material. Int J Cardiol. 2017;248:396–402.CrossRefGoogle Scholar
  29. 29.
    Gomes A, Glaudemans AWJM, Touw DJ, van Melle JP, Willems TP, Maass AH, Natour E, NHJ P, RJH B, van Geel PP, RHJA S, van Assen S, Sinha B. Diagnostic value of imaging in infective endocarditis: a systematic review. Lancet Infect Dis. 2017;17(1):e1–e14.CrossRefGoogle Scholar
  30. 30.
    Baumgartner P, Bonhoeffer NM, Groot D, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010;31(23):2915–57.CrossRefGoogle Scholar
  31. 31.
    Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53:436–44.CrossRefGoogle Scholar
  32. 32.
    Olmos C, Vilacosta I, Habib G, Maroto L, Fernández C, et al. Risk score for cardiac surgery in active left-sided infective endocarditis. Heart. 2017;103(18):1435–42.CrossRefGoogle Scholar
  33. 33.
    Duval X, Iung B, Klein I, IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010;152:497–504.CrossRefGoogle Scholar
  34. 34.
    Cantier M, Mazighi M, Klein I, Desilles JP, Wolff M, et al. Neurologic complications of infective endocarditis: recent findings. Curr Infect Dis Rep. 2017;19(11):41.CrossRefGoogle Scholar
  35. 35.
    Merkler AE, Chu SY, Lerario MP, Navi BB, Kamel H. Temporal relationship between infective endocarditis and stroke. Neurology. 2015;85(6):512–6.CrossRefGoogle Scholar
  36. 36.
    Yanagawa B, Pettersson GB, Habib G, Ruel M, Saposnik G, Latter DA, Verma S. Surgical management of infective endocarditis complicated by embolic stroke: practical recommendations for clinicians. Circulation. 2016;134(17):1280–92.CrossRefGoogle Scholar
  37. 37.
    Fournier PE, Thuny F, Richet H, et al. Comprehensive diagnostic strategy for blood-negative endocarditis: a prospective study of 819 cases. Clin Infect Dis. 2010;51:131–40.CrossRefGoogle Scholar
  38. 38.
    Barsic B, Dickerman S, Krajinovic V, et al. International Collaboration on Endocarditis – Prospective Cohort Study (ICE-PCS) investigators. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013;56:209–17.CrossRefGoogle Scholar
  39. 39.
    AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, Writing Committee, Hussain ST, Griffin B, Blackstone EH, Gordon SM, SA LM, Woc-Colburn LE. The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg. 2017;153(6):1241–58.CrossRefGoogle Scholar
  40. 40.
    Steiner T, Juvela S, Unterberg A, European Stroke Organization, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebovasc Dis. 2013;35:93–112.CrossRefGoogle Scholar
  41. 41.
    Legrand M, Pirracchio R, Rosa A, et al. Incidence, risk factors and prediction of post-operative acute kidney injury following cardiac surgery for active endocarditis: an observational study. Crit Care. 2013;17:R220.CrossRefGoogle Scholar
  42. 42.
    Botelho‐Nevers E, Thuny F, Casalta JP, Richet H, Gouriet F, Collart F, Riberi A, Habib G, Raoult D. Dramatic reduction in infective endocarditis‐related mortality with a management‐based approach. Arch Intern Med. 2009;169:1290–8.CrossRefGoogle Scholar
  43. 43.
    Chirillo F, Scotton P, Roco F, et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis. Am J Cardiol. 2013;112:1171–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.ACHD Unit, Cardiology Department and M3C center of reference for complex congenital defectsHôpital Européen Georges PompidouParisFrance

Personalised recommendations