Abstract 18856: Patients With Mild Congenital Heart Disease Lesions Are at High Risk of Infective Endocarditis: A UK Tertiary Centre Experience
Introduction: Infective Endocarditis (IE) is a serious complication in patients with congenital heart disease (CHD). This study reviews the characteristics of patients with IE and CHD presenting to a UK tertiary centre, from 2008 when the new NICE guidelines on antibiotic prophylaxis were applied
Methods: All cases of IE in patients with CHD presented at St Thomas’ and Evelina Hospital between 2008 and 2015 were retrieved. Using the NICOR database and our electronic record, we reviewed: type of CHD, site of IE, presence of prosthetic material, recent dental procedure or other interventions, antibiotic prophylaxis, microbiology, echocardiographic features, treatment and outcome
Results: 65 cases of Ιε were identified (mean age 17 years, range 1 month -52 years, 46 male). Patients with complex cyanotic CHD were the most affected (35%) followed by patients with unrepaired ventricular septal defect (22%), and bicuspid aortic valve (12%). Fifty patients had signs of endocarditis on echocardiography. Native valves were most commonly affected (n=40) with the aortic valve/root in 45% of patients, followed by tricuspid valve (30%), mitral valve (30%) and pulmonary valve (5%); 4 patients had more than one valve involved. In patients with prosthetic material (n=20), RV-PA conduit was mostly affected (58.5%), followed by aortic stent/graft for aortic coarctation (21%), prosthetic aortic valve 10.5%, BT shunt 5% and PDA stent (5%). 10 patients had a dental procedure within 3 months prior to the IE, whereas 16 patients had other type of invasive procedures. Streptococcus species was the most frequent organism (n=29, 45%) followed by Staphylococcus in 13 cases (20%). Surgery was required in 66% of cases during the same admission. In-hospital mortality was 6.1%.
Conclusions: IE in patients with CHD is associated with high hospital mortality and often requires surgery during the same hospital admission. Patients with complex cyanotic CHD are known to be at high risk of developing IE and this is confirmed by our study; however patients with “mild” CHD lesions are also at high risk. These results would suggest the need to review the current NICE guidelines which should further consider the effect of flow dynamics in the pathogenesis of IE.
Author Disclosures: A. Koutsoukis: None. R. Lakhani: None. N. Chung: None. Y. Emmanuel: None. C. Kiesewetter: None. C. Head: None. B. Prendergast: None. J. Chambers: None. D. Anderson: None. C. Austin: None. A. Frigiola: None.
- © 2016 by American Heart Association, Inc.