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Infective endocarditis in congenital heart disease

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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.

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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

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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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Authors and Affiliations

  1. Division of Pediatric Cardiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Walter Knirsch

  2. Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Zurich, Switzerland

    David Nadal

  3. Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland

    Walter Knirsch & David Nadal

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  1. Walter Knirsch
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  2. David Nadal
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Correspondence to Walter Knirsch.

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This work is dedicated to the memory of Professor Urs Bauersfeld (1956–2010).

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Knirsch, W., Nadal, D. Infective endocarditis in congenital heart disease. Eur J Pediatr 170, 1111–1127 (2011). https://doi.org/10.1007/s00431-011-1520-8

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