Incidence, clinical characteristics and prognosis of infective endocarditis in patients with congenital heart disease

Abstract

Infective endocarditis (IE) is a life threatening complication in patients with congenital heart disease (CHD). We aimed to determine the incidence, clinical features and outcomes of IE in patients with CHD. A retrospective single centre review of patients who presented IE (defined by modified Duke criteria) admitted on the cardiology B department of Fattouma Bourguiba University Hospital between January 1998 and march 2015. Among the 235 patients included, 10.2% (24 patients) had CHD. The most frequent CHD was ventricular septal defect (30%). Patients with CHD had lower mean age (24 ± 10 years vs. 38 ± 17 years, P < 0.0001). There was no significant difference for sex. Comorbidity in patients with CHD was low. The most common valves involved were tricuspid and aortic valve (19% vs. 5.44%–14.3% vs. 12.4%, P < 0.0001 respectively). Half of blood-culture was negative. Among culture-positive patients, staphyloccocus species was the most frequently implicated as causative pathogen. Detection of vegetation on trans-thoracic and trans-oesophageal echocardiography was not significantly different (91.3% vs. 81.3%, P = 0.186 and 100% vs. 91.8%, P = 0.3 respectively). Heart failure, embolic events, cerebro-vascular complications and in-hospital mortality were similar compared to patients without CHD. Population with CHD had higher recurrence rate of IE (33.3% vs. 9.1%, P = 0.023). IE in patients with CHD occurs at young age. It implicates most commonly right heart and aortic valve. Its prognosis is not different from IE in the general population but has higher recurrence rate.