scholarly journals Diagnostic Strategy for Infective Endocarditis in Patients With Adult Congenital Heart Disease

2021 ◽  
Author(s):  
Takahiro Ohara
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Diagnostic Strategy ◽  
Adult Congenital

Predictive factors of death associated with infective endocarditis in adult patients with congenital heart disease

2020 ◽  
pp. 204887262090139
Author(s):  
Reaksmei Ly ◽  
Fabrice Compain ◽  
Bamba Gaye ◽  
Florence Pontnau ◽  
Melissa Bouchard ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Predictive Factors ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Adult Patients ◽  
Hospital Death ◽  
Adult Congenital

Aims: Infective endocarditis is a severe infection which can occur in adult patients with congenital heart disease. We aimed to determine outcomes and risk factors of death in adult congenital heart disease and to investigate differences with infective endocarditis in non-congenital heart disease. Methods and results: Between March 2000 and June 2018, 671 consecutive episodes of infective endocarditis in adult patients were retrospectively recorded. Cases were classified according to the modified Duke classification. All adult congenital heart disease cases were managed by infectious disease specialists and adult congenital heart disease cardiologists. During this period, 142 infective endocarditis episodes (21%) occurred in adult congenital heart disease patients with simple (46.5%), moderate (21.1%), or complex (32.4%) congenital heart disease. In-hospital mortality was 12.7%. The strongest predictive factors of in-hospital death in multivariate analysis were complexity of congenital heart disease (odds ratio (OR) 8.02, 95% confidence interval (CI) 1.53–42.07), age (OR 1.05, 95% CI 1.00–1.19) and white blood cell count 12 g/L or greater (OR 8.72, 95% CI 2.42–31.43). Patients with congenital heart disease were significantly younger (median age 36 vs. 67 years, P<0.001), had undergone more redo cardiac surgeries (35.7% vs. 11.3%, P<0.01) and presented with more right-sided infective endocarditis (39.4% vs. 7.9%, P<0.01) than patients without congenital heart disease. Congenital heart disease was associated with two-fold lower in-hospital mortality rates (OR 0.37, 95% CI 0.19–0.74), independently of age, gender, obesity, renal function and side of infective endocarditis. Conclusion: Although mortality associated with infective endocarditis is lower in adult patients with congenital heart disease than patients without congenital heart disease, infective endocarditis mortality is particularly high in patients with complex congenital heart disease. Education and prevention about the risk of infective endocarditis is essential, especially in this group.

scholarly journals Adult congenital heart disease: A substrate for infective endocarditis

2015 ◽  
Vol 34 (2) ◽  
pp. 145-146
Author(s):  
Mariana Faustino ◽  
António Freitas ◽  
Ana Oliveira Soares ◽  
José Fragata ◽  
Victor M. Gil ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Adult Congenital

Infective endocarditis in adults with congenital heart disease remains a lethal disease

Heart ◽  
2017 ◽  
Vol 104 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Oktay Tutarel ◽  
Rafael Alonso-Gonzalez ◽  
Claudia Montanaro ◽  
Renee Schiff ◽  
Aitor Uribarri ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Morbidity And Mortality ◽  
Tertiary Centre ◽  
Duke Criteria ◽  
Increased Risk ◽  
Adult Congenital

ObjectiveInfective endocarditis (IE) is associated with significant morbidity and mortality. Patients with adult congenital heart disease (ACHD) have an increased risk of developing IE. The aim of this study is to describe the incidence, predictors of outcome and mortality associated with IE in ACHD in a contemporary cohort.MethodsAll episodes of IE in adults with congenital heart disease referred to our tertiary centre between 1999 and 2013 were included in the study. Patients were identified from the hospital database. The diagnosis of endocarditis was established according to the modified Duke criteria. The primary endpoint of the study was endocarditis-associated mortality.ResultsThere were 164 episodes of IE in 144 patients (male 102, 70.8%). Mean age at presentation was 32.3±22.7 years. Out of these, 43% had a simple, 23% a moderate and 32% a complex lesion. It was at least the second bout of IE in 37 episodes (23%). A predisposing event could be identified in only 26.2% of episodes. Surgical intervention during the same admission was performed in 61 episodes (37.2%). During a median follow-up of 6.7 years (IQR 2.9–11.4), 28 (19.4%) patients died. Out of these, 10 deaths were related to IE (IE mortality 6.9%). On unvariate regression analysis, the development of an abscess (OR: 7.23; 95% CI 1.81 to 28.94, p<0.01) and age (OR: 1.05; 95% CI 1.01 to 1.10, p=0.03) were the only predictors of IE-associated mortality. There was no increase in IE cases at our centre during the period of the study.ConclusionsIE-associated morbidity and mortality in a contemporary cohort of ACHD patients is still high in the current era.

scholarly journals Blood culture negative infective endocarditis in adult congenital heart disease patients with prosthetic grafts: a case series

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Myo Thidar Lwin ◽  
Victor Tsoi ◽  
Tat Yam ◽  
Aisling Carroll ◽  
Tony Salmon ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Management Strategy ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Pet Ct ◽  
Adult Congenital ◽  
Culture Negative

Abstract Background Blood culture negative infective endocarditis (BCNIE) is often a diagnostic challenge in adult congenital heart disease patients leading to misdiagnosis, treatment delay and associated high mortality. Studies of BCNIE in adult congenital heart disease patients repaired with prosthetic cardiovascular grafts are limited. Case summary We report two cases of BCNIE where serology testing, multiple polymerase chain reaction testing of explanted valve material and multi-modality imaging including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were utilized not only to confirm the diagnosis but also to guide management strategy and inform prognosis. Both patients were treated successfully with cardiac surgery and prolonged anti-microbial therapy. Discussion Clinical presentation of BCNIE in repaired CHD patients is highly variable. The symptoms are often non-specific with subacute or chronic presentation. This may mislead initial diagnosis and subsequent management. Multi-modality imaging including PET/CT should be considered to support the diagnosis, define the extent of infection, decide the management strategy and inform prognosis in patients. A thorough history of animal exposure, and consideration of serology and multiple molecular testing to identify the causative organism, is critical in the management of BCNIE.

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