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Infective endocarditis in a cohort of adult congenital heart disease patients
Session:
Painel 10 - Doença Valvular 4
Speaker:
Tânia Branco Mano
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Posters
FP Number:
---
Authors:
Tânia Branco Mano; Ana Figueiredo Agapito; Lidia De Sousa; André Viveiros Monteiro; Tiago Rito; José Miguel Viegas; Isabel Gonçalves Machado Cardoso; André Grazina; António Valentim Gonçalves; Tiago Mendonça; Alexandra Castelo; Vera Ferreira; Pedro Garcia Brás; Luisa Moura Branco; Joana Gomes Feliciano; Maria De Fátima Pinto; José Fragata; Rui Cruz Ferreira
Abstract
<p>Background: Congenital heart disease (CHD) increases the risk of infective endocarditis (IE) due to the substrate of prosthetic materials and residual lesions. However, the evidence base in these pts is limited, and the lesion-specific risk and mortality are poorly defined.</p> <p>Purpose: Analyse clinical course, predisposing factors and long-term follow-up of IE in the adult population with CHD followed in our tertiary centre.</p> <p>Methods: We retrospectively reviewed all cases of proven and probable IE (Duke's criteria) in our adult CHD database between 1970 and November 2019. Epidemiological, clinical and imaging data were analysed. Predictors of complications, surgical treatment and mortality were assessed using regression analysis.</p> <p>Results: 95 pts were included (57% males, mean age 43.7±14.8 years, mean follow-up of 13.8±10 years). A minority had EI at pediatric age (18%). Prior corrective or palliative surgery was performed in 32% and 10%, respectively. The most frequent diagnoses were: ventricular septal defect -VSDs (N=21; 22%), bicuspid aortic valve - BAV (N=19; 20%) and Tetralogy of Fallot (N=10; 10.5%). An echocardiographic demonstration of vegetation was possible in 68% (N=65): aortic valve (N=24), tricuspid valve (N=11), mitral valve (N= 11), aortic prosthesis (N=6), pulmonary valve (N=5), VSD (N=3), mitral prosthesis (N=2), pacemaker lead (N=2), aortic coarctation (N=2), pulmonary prosthesis (N=1) and aortic conduct (N=1). A pathogen was isolated in 59% of cases, being streptococci (N=29) and staphylococci (N=10) the predominant pathogens. Nineteen pts had systemic embolization and seven recurrent episodes. Surgical management was necessary in 40% of cases in acute phase, 34% of this pts with prior surgery. We did not find significant relation between acute and prior surgery. The mortality rate (< 1 year) due to EI was 10.5% (N=10). Mortality were associated with congestive heart failure at presentation (p=0.002, OR 8.5 – CI 95% 2.06-35.8) and with conservative management (p=0.002, OR 8.9).</p> <p>Conclusions: In an adult CHD cohort, IE was more frequent in pts with non-corrected native-valve, particularly with VSDs and BAV. This finding contradicts the current guidelines that excludes them from prophylaxis. Surgical treatment is often necessary and mortality remains substantial, however lower than described in general population. Congestive heart failure at presentation and non-surgical management were risk factors for mortality in this cohort.</p>
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