Clinical outcomes for congenital heart disease patients presenting with infective endocarditis

ABSTRACT

Introduction

Infective endocarditis (IE) is a life-threatening adverse event for patients with congenital heart disease (CHD). Its incidence has changed little over time despite progress in techniques for diagnosis and treatment, and guidelines for prophylaxis.

Areas covered

The review sought for key-words: ‘congenital heart disease,’ ‘infective endocarditis,’ ‘microbial diagnosis,’ ‘imaging diagnosis,’ ‘surgical techniques,’ ‘prognosis,’ ‘prophylaxis.’ Objectives were to investigate epidemiology, novel techniques for imaging and microbial diagnosis, therapeutic management and prognosis, and guidelines for prophylaxis in patients with CHD. The incidence of IE is increasing in adults with CHD. Morbidity caused by a broad clinical spectrum of cardiac and extracardiac episode-related complications is high. Surgical management is increasingly required in the early phase of the disease. Despite new techniques for diagnosis and microbiological therapy, mortality rate is still up to 10–20%.

Expert opinion

IE has increased in the growing cohort of adults with complex heart disease, living with residual cardiac lesions and prosthetic materials. Diagnosis is challenging for complex heart defects. Pet-scan technique can provide beneficial information to locate intracardiac lesions and embolic foci. Identification of the microbiological agents is improving. Innovative surgical techniques aim to avoid prosthetic material. Guidelines for prophylaxis currently emphasize oral and skin daily hygiene.

KEYWORDS:

• Congenital heart disease
• infective endocarditis
• microbial diagnosis
• imaging diagnosis
• surgical techniques
• prognosis
• prophylaxis

Article highlights

• The incidence of infective endocarditis is increasing in adults with congenital heart disease.

• Infective endocarditis in congenital heart disease is a life long and life-threatening adverse event.

• Staphylococci are the main causative agent of infective endocarditis in patients with congenital heart disease.

• The PCR technique can improve microbial diagnosis.

• The Pet/scan technique can detect intracardiac and extracardiac infective foci.

• Early surgery with preferred nonprosthetic materials is increasingly performed.

• The prognosis of infective endocarditis in congenital heart disease has little evolved over time.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.