Jose Loureiro-Amigo1, Nuria Fernández-Hidalgo2, Antonia Pijuan-Domènech3, Laura Dos-Subirà4, Teresa Subirana-Domènech5, Teresa Gonzàlez-Alujas6, Juan José González-López7, Pilar Tornos-Mas6, David García-Dorado6, Benito Almirante8. 1. Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España. 2. Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: nufernan@gmail.com. 3. Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España. 4. Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España. 5. Universitat Autònoma de Barcelona, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 6. Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España. 7. Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, España. 8. Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España.
Abstract
INTRODUCTION: A growing number of patients with congenital heart disease (CHD) will reach adulthood. Infective endocarditis (IE) is a major complication in this population. The aim of this study was to describe the features of IE in adults with CHD treated in a reference centre. METHODS: A retrospective review was performed on a cohort of patients over 16 years of age with CHD who presented with IE (defined by the modified Duke criteria) between 1996 and 2014. Only the first episode from each patient was considered for the descriptive analysis. RESULTS: IE was observed in 27 patients. The median age at diagnosis of IE was 27.7 years, and 63% were male. Comorbidity was low (median Charlson index was 0). IE was mostly community-acquired (78%). The most frequent CHD were ventricular septal defect (33%). A repair was performed in 48% of patients, and 19% received palliative treatment. Forty-one percent of patients had some type of prosthesis. A residual defect was observed in 81%. The IE was detected in the right side of 44% of the patients. The most frequent aetiological agents were viridans group streptococci (41%) and Staphylococcus epidermidis (30%). Surgery was required to treat IE in 37% of patients. There were five re-infections and three relapses. Two patients died, both as a result of recurrence. CONCLUSIONS: IE in adults with CHD occurred in young patients, and almost all of them carried some prosthetic material or a residual defect. The IE is frequently right-sided. Although surgical treatment was required in many cases, mortality was low, except in the case of relapses. Copyright Â
INTRODUCTION: A growing number of patients with congenital heart disease (CHD) will reach adulthood. Infective endocarditis (IE) is a major complication in this population. The aim of this study was to describe the features of IE in adults with CHD treated in a reference centre. METHODS: A retrospective review was performed on a cohort of patients over 16 years of age with CHD who presented with IE (defined by the modified Duke criteria) between 1996 and 2014. Only the first episode from each patient was considered for the descriptive analysis. RESULTS: IE was observed in 27 patients. The median age at diagnosis of IE was 27.7 years, and 63% were male. Comorbidity was low (median Charlson index was 0). IE was mostly community-acquired (78%). The most frequent CHD were ventricular septal defect (33%). A repair was performed in 48% of patients, and 19% received palliative treatment. Forty-one percent of patients had some type of prosthesis. A residual defect was observed in 81%. The IE was detected in the right side of 44% of the patients. The most frequent aetiological agents were viridans group streptococci (41%) and Staphylococcus epidermidis (30%). Surgery was required to treat IE in 37% of patients. There were five re-infections and three relapses. Two patients died, both as a result of recurrence. CONCLUSIONS: IE in adults with CHD occurred in young patients, and almost all of them carried some prosthetic material or a residual defect. The IE is frequently right-sided. Although surgical treatment was required in many cases, mortality was low, except in the case of relapses. Copyright Â