[Endocarditis and congenital heart disease in the adult].
The prevalence of congenital cardiopathy is approximately 8% of live births, and 80 to 85% of patients reach adulthood thanks to the progress in the management of even complex malformations. Congenital cardiopathies represent 10 to 18% of adulthood cardiopathies complicated by infectious endocarditis, and in the specialist units for adolescent and adult congenital cardiac patients, 5% of admissions are provoked by endocarditis. The majority of malformations have a risk of infected graft, but patients who have a complex cyanogenic cardiopathy or an operated cardiopathy requiring insertion of prosthetic material, and those who have already had previous episodes of endocarditis are at a very high risk. Longitudinal studies show evolution of the responsible microbes, with an increase of the HACEK group; nevertheless, the streptococci and staphylococci remain uppermost. Diagnosis relies on the classic Duke University criteria but Doppler echocardiography is sometimes difficult to interpret in complex malformations or extra-cardiac sites of infection, and in 6 to 11% of cases the microbe is not identified. Infectious endocarditis remains a particularly serious complication: 50% of patients have aggravation of their cardiopathy and 20 to 30% require surgery; however the mortality has fallen by 20% to a little less than 5% in the most recent series. It is vital that patient education should be pursued even if, in certain circumstances, prophylaxis is not always either possible or effective....
Lefèvre
M
M
Clinique cardiologique, CHU Nantes, hôpital G. et R. Laënnec, bd Jacques Monod, 44093 Nantes.
Guérin
P
P
D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D010353:Patient Education as Topic; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors