What Are the Key Considerations for the Prevention of Infective Endocarditis in Adults with Congenital Heart Disease?
There have been major changes in the epidemiology of infective endocarditis over the past 20 years. Although the incidence of rheumatic valvular disease has declined, the survival of congenital heart disease has increased, as has the use of cardiovascular prosthetic devices. Despite new and powerful antibiotics, drug resistant organisms are emerging, and overall mortality remains as high as 30%. Therefore, the focus remains on primary prevention. The general considerations for infective endocarditis prophylaxis in adult congenital heart disease (ACHD) are reviewed in the 1997 American Heart Association recommendations. However, there are some considerations specific to the ACHD population. Vegetations form on endothelial or endocardial surfaces subjected to turbulent flow. Classically, they occur on the flow surfaces of valves (the atrial surface of the atrioventricular valves and the ventricular surface of the semilunar valves). In congenital heart disease, vegetations must be sought