Clinical course and complications of infective endocarditis in patients growing up with congenital heart disease.
BACKGROUND
Although a high number of patients with congenital heart disease (CHD) undergo surgical palliation or definite correction up to adolescence, adult congenital heart disease (ACHD) may remain a potential lifelong risk factor for infective endocarditis (IE) in patients growing up with congenital heart disease (GUCH).


METHODS
In a retrospective case study of a tertiary care center long-term clinical course and complications of patients with IE and GUCH were analysed.


RESULTS
Data of 52 patients with CHD, who fulfilled the Saiman criteria for infective endocarditis and were treated between April 1986 and March 2001, were identified: Risk factors for infective endocarditis were previous cardiovascular operation (51.9%), use of foreign material (38.5%), dental or other surgical procedures without recommended antibiotic prophylaxis (25.0%), or cardiac catheterization (5.8%). Staphylococcal (38.9%) or streptococcal species (35.2%) were cultivated in most cases as causative microorganisms. Complications were: recurrence of IE (7.7%), septic embolisms (30.8%) leading to central nervous complications (7.7%), embolism of pulmonary arteries (7.7%), renal arteries (1.9%), arteries of the extremities (9.6%), or infarction of spleen (1.9%). Other cardiac (23.1%) or extracardiac (13.5%) complications were frequent. The need of re-operations during or after IE was high (67.3%). The hospital mortality was 1.9%, late mortality was 7.7%.


CONCLUSIONS
Patients with IE and CHD show a broad clinical spectrum of cardiac and extracardiac complications. They may lead to a complicative short- and long-term course with the potential risk of death and a high number of re-operation. Efforts have to be made to improve long-term outcome of patients with ACHD by an interdisciplinary cooperation.
Knirsch
Walter
W
Department of Pediatric Cardiology and Pediatric Intensive Care, Kinderherzzentrum, Zentrum für Erwachsene mit angeborenen Herzfehlern, Olgahospital, Stuttgart, Germany. w.knirsch@web.de
Haas
Nikolaus A
NA
Uhlemann
Frank
F
Dietz
Klaus
K
Lange
Peter E
PE
D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003777:Dental Prophylaxis / Q000009:adverse effects; D004697:Endocarditis, Bacterial / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors