Infective endocarditis in congenital heart disease

Abstract

The occurrence rate of infective endocarditis (IE) in adults with congenital heart disease (CHD) is more than ten times that is seen in normal population. Though the prognosis of IE is better in CHD compared with acquired heart disease, mortality remains high, with a reported variety between 4 and 10 %. Patients with pulmonary valve stenosis and those with secundum atrial septal defect are believed to have a low risk of IE as long as these conditions are not related with additional lesions. For the diagnosis of IE, echocardiography has a crucial role. Transesophageal echocardiography in adult CHD is indicated, if transthoracic echocardiography is equivocal or when there is a complex congenital heart anatomy or a valve prosthesis in which transthoracic windows may be inadequate. Recent guidelines specifically recommend no IE prophylaxis for nondental procedures like esophagogastroduodenoscopy and colonoscopy as well as gastrointestinal and genitourinary procedures in the absence of active infection. It is now commended by expert consensus to limit antibiotic prophylaxis to patients with the very high risk of IE experiencing the highest-risk procedures, namely, patients with previous IE, patients with a prosthetic valve or a prosthetic material that used for cardiac valves repair, and also patients with CHD. Physicians must recall that cyanotic patients with right-to-left shunts have the probability of “paradoxical” systemic embolization, which renders them at risk of stroke. Also, air filters should be used so as to avoid the injection of air bubbles. In order to lessen the risk of IE, maintenance of oral hygiene, regular dental review, and avoidance from getting piercings and tattoos are worth considering.