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Eerdekens GJ, Van Beersel D, Rex S, Gewillig M, Schrijvers A, Al Tmimi L. The patient with congenital heart disease in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:421-436. [PMID: 37938087 DOI: 10.1016/j.bpa.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
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Affiliation(s)
- Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Dieter Van Beersel
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - An Schrijvers
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
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2
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Infective endocarditis in a cohort of adult CHD patients. Cardiol Young 2023; 33:190-195. [PMID: 35241206 DOI: 10.1017/s1047951122000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND CHD increases the risk of infective endocarditis due to the substrate of prosthetic materials and residual lesions. However, lesion-specific and mortality risks data are lacking. We sought to analyse clinical course and mortality of infective endocarditis in a cohort of adult CHD. METHODS Retrospective analysis of all cases of proven and probable infective endocarditis (Duke's criteria) followed in our adult CHD clinic between 1970 and August, 2021. Epidemiological, clinical and imaging data were analysed. Predictors of surgical treatment and mortality were assessed using regression analysis. RESULTS During a mean follow-up of 15.8 ± 10.9 years, 96 patients had 105 infective endocarditis episodes, half with previous cardiac surgery (corrective or palliative). The most frequent diagnoses were: ventricular septal defect, bicuspid aortic valve, Tetralogy of Fallot and pulmonary atresia. The site of infection was identified by echocardiography in 82 episodes (91%), most frequently in aortic (n = 27), tricuspid (n = 15), and mitral (n = 13) valves. Blood cultures were positive in 79% of cases, being streptococci (n = 29) and staphylococci (n = 23) the predominant pathogens. Surgery was necessary in 40% and the in-hospital mortality was 10.5%, associated with heart failure (p < 0.001; OR 13.5) and a non-surgical approach (p = 0.003; OR 5.06). CONCLUSIONS In an adult CHD cohort, infective endocarditis was more frequent in patients with ventricular septal defect and bicuspid aortic valves, which contradicts the current guidelines that excludes them from prophylaxis. Surgical treatment is often required and mortality remains substantial. Prevention of this serious complication should be one of the major tasks in the care of adults with CHD.
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3
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Verheijen DBH, Stöger JL, van der Kley F, Schalij MJ, Jongbloed MRM, Vliegen HW, Kiès P, Egorova AD. A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview. Front Cardiovasc Med 2022; 9:1012147. [PMID: 36620635 PMCID: PMC9815109 DOI: 10.3389/fcvm.2022.1012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d'entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic "sawtooth" pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.
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Affiliation(s)
- D. B. H. Verheijen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J. Lauran Stöger
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - F. van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. J. Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. R. M. Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - H. W. Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - P. Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - A. D. Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: A. D. Egorova,
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4
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Everett AE, Barrios P, Karamlou T, Phillips A, Ahmad M, Najm HK. Unexpected Septal and Truncal Valve Endocarditis After Transcatheter Pulmonary Valve Replacement. Ann Thorac Surg 2021; 114:e169-e172. [PMID: 34968446 DOI: 10.1016/j.athoracsur.2021.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
Despite early clinical success of transcatheter pulmonic valve replacement (TPVR), there is concern for an increased risk of endocarditis requiring complex surgery to repair. We present a case of endocarditis of a Melody® valve in a 33 year old male patient with prior neonatal repair of persistent truncus arteriosus and two subsequent right ventricular outflow tract to pulmonary artery conduit (RVOT-to-PA conduit) replacements. The infection had extended from the Melody® valve through the prior ventricular septal defect patch to the truncal valve and highlights the risk of endocarditis particularly with the Melody® transcatheter valve.
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Affiliation(s)
- Andrew E Everett
- Cleveland Clinic Children's Hospital Dept. of Pediatric and ConZgenital Cardiology and Heart Surgery. 9500 Euclid Ave.; Cleveland OH 44195.
| | - Paola Barrios
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. 9500 Euclid Ave.; Cleveland OH 44195
| | - Tara Karamlou
- Cleveland Clinic Children's Hospital Dept. of Pediatric and ConZgenital Cardiology and Heart Surgery. 9500 Euclid Ave.; Cleveland OH 44195
| | - Alistair Phillips
- Cleveland Clinic Children's Hospital Dept. of Pediatric and ConZgenital Cardiology and Heart Surgery. 9500 Euclid Ave.; Cleveland OH 44195
| | - Munir Ahmad
- Cleveland Clinic Children's Hospital Dept. of Pediatric and ConZgenital Cardiology and Heart Surgery. 9500 Euclid Ave.; Cleveland OH 44195
| | - Hani K Najm
- Cleveland Clinic Children's Hospital Dept. of Pediatric and ConZgenital Cardiology and Heart Surgery. 9500 Euclid Ave.; Cleveland OH 44195
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Zhang Y, Williams H, Pucar D. FDG-PET Identification of Infected Pulmonary Artery Conduit Following Tetralogy of Fallot (TOF) Repair. Nucl Med Mol Imaging 2016; 51:86-87. [PMID: 28250862 DOI: 10.1007/s13139-016-0424-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022] Open
Abstract
Tetralogy of Fallot (TOF) is one of the most common forms of cyanotic congenital heart disease usually managed by serial surgical repairs. The repaired prosthetic valve or conduit is susceptible to life-threatening infection. FDG-PET is an effective alternative to evaluate the source of infection when other examinations are inconclusive. We report an unusual case of an infected pulmonary artery conduit after TOF repair although the echocardiogram was negative for vegetation, which was later confirmed by surgery and pathology. The case highlights the role of FDG-PET as a problem-solving tool for potential endocarditis and cardiac device infection cases after complex cardiac surgery.
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Affiliation(s)
- Yuyang Zhang
- Department of Radiology, Medical College of Georgia, Augusta, GA 30912 USA
| | - Hadyn Williams
- Department of Radiology, Medical College of Georgia, Augusta, GA 30912 USA
| | - Darko Pucar
- Department of Radiology, Medical College of Georgia, Augusta, GA 30912 USA
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6
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Percutaneous pulmonary valve endocarditis: Incidence, prevention and management. Arch Cardiovasc Dis 2014; 107:615-24. [DOI: 10.1016/j.acvd.2014.07.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 02/07/2023]
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7
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Souaga KA, Kramoh KE, Katche KE, Kirioua Kamenan YA, Amani KA, N'goran YK, Kangah MK, Kakou MG. [Infective endocarditis complicating patent ductus arteriosus: emergency surgical treatment of two cases]. Ann Cardiol Angeiol (Paris) 2011; 61:125-7. [PMID: 21272857 DOI: 10.1016/j.ancard.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
Abstract
Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience.
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Affiliation(s)
- K A Souaga
- Service de chirurgie cardiovasculaire, institut de cardiologie, Abidjan, Cote d'Ivoire.
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8
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van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJM. The changing epidemiology of congenital heart disease. Nat Rev Cardiol 2010; 8:50-60. [PMID: 21045784 DOI: 10.1038/nrcardio.2010.166] [Citation(s) in RCA: 462] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital heart disease is the most common congenital disorder in newborns. Advances in cardiovascular medicine and surgery have enabled most patients to reach adulthood. Unfortunately, prolonged survival has been achieved at a cost, as many patients suffer late complications, of which heart failure and arrhythmias are the most prominent. Accordingly, these patients need frequent follow-up by physicians with specific knowledge in the field of congenital heart disease. However, planning of care for this population is difficult, because the number of patients currently living with congenital heart disease is difficult to measure. Birth prevalence estimates vary widely according to different studies, and survival rates have not been well recorded. Consequently, the prevalence of congenital heart disease is unclear, with estimates exceeding the number of patients currently seen in cardiology clinics. New developments continue to influence the size of the population of patients with congenital heart disease. Prenatal screening has led to increased rates of termination of pregnancy. Improved management of complications has changed the time and mode of death caused by congenital heart disease. Several genetic and environmental factors have been shown to be involved in the etiology of congenital heart disease, although this knowledge has not yet led to the implementation of preventative measures. In this Review, we give an overview of the etiology, birth prevalence, current prevalence, mortality, and complications of congenital heart disease.
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Affiliation(s)
- Teun van der Bom
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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9
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary. Circulation 2008; 118:2395-451. [DOI: 10.1161/circulationaha.108.190811] [Citation(s) in RCA: 490] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 624] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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13
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Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 2007; 138:739-45, 747-60. [PMID: 17545263 DOI: 10.14219/jada.archive.2007.0262] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997. METHODS AND RESULTS A writing group appointed by the AHA for their expertise in prevention and treatment of infective endocarditis (IE) with liaison members representing the American Dental Association, the Infectious Diseases Society of America and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on IE. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and IE; in vitro susceptibility data of the most common microorganisms, which cause IE; results of prophylactic studies in animal models of experimental endocarditis; and retrospective and prospective studies of prevention of IE. MEDLINE database searches from 1950 through 2006 were done for English language articles using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization and bacteremia. The reference lists of the identified articles were also searched. The writing group also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The article subsequently was reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS The major changes in the updated recommendations include the following. (1) The committee concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective. (2) IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when IE prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
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Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 139 Suppl:3S-24S. [PMID: 17446442 DOI: 10.14219/jada.archive.2008.0346] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
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15
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Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736-54. [PMID: 17446442 DOI: 10.1161/circulationaha.106.183095] [Citation(s) in RCA: 1357] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
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16
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Baek JS, Bang JS, Bae EJ, Noh CI, Lee HJ, Choi JY, Yoon YS, Sohn DW, Oh BH. Current Characteristics of Infective Endocarditis with Congenital Heart Disease: A Retrospective Survey of 121 Cases between 1985 and 2006. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.12.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jae Suk Baek
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Seok Bang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hoan-Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Yeun Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Soo Yoon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Won Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Hee Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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17
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Ozkokeli M, Ates M, Uslu N, Akcar M. Pulmonary and Aortic Valve Endocarditis in an Adult Patient With Silent Patent Ductus Arteriosus. ACTA ACUST UNITED AC 2004; 45:1057-61. [PMID: 15655282 DOI: 10.1536/jhj.45.1057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary and aortic valve endocarditis are uncommon especially in an adult patient with patent ductus arteriosus. A 27-year-old woman diagnosed with pulmonary and aortic valve endocarditis underwent surgical treatment. Here, we report our clinical and surgical experience in treating a case of double valve endocarditis with clinically silent patent ductus arteriosus.
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Affiliation(s)
- Mehmet Ozkokeli
- Department of Cardiovascular Surgery, Abant Izzet Baysal University, Izzet Baysal Medical Faculty, Bolu, Turkey
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Spivack E. Tetralogy of Fallot: an overview, case report, and discussion of dental implications. SPECIAL CARE IN DENTISTRY 2001; 21:172-5. [PMID: 11803640 DOI: 10.1111/j.1754-4505.2001.tb00250.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tetralogy of Fallot (TOF) is the most common cause of cyanotic heart disease. The anatomic defects comprising TOF lead to the systemic circulation of oxygen-poor (desaturated) blood, resulting in symptoms of cyanosis, polycythemia, and hypoxia. Untreated, most patients with this disorder die during childhood. Surgical treatment aimed at correcting the defects is currently recommended for infants. Long-term studies have reported good results with this approach. The case history of a four-year-old male with uncorrected tetralogy of Fallot is presented. The patient required extensive dental treatment prior to scheduled cardiac catheterization. The dental findings and plan of care for this patient are detailed, and attention is given to the role of the medical work-up, preoperative antibiotics, and sedatives. It is stressed that the dental treatment plan for patients with tetralogy of Fallot must take into account the patients' medical status both prior to and following corrective surgical procedures.
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Affiliation(s)
- E Spivack
- Special Dental Services, Department of Dentistry, St. Joseph's Hospital and Medical Center, 703 Main Street, Paterson, NJ 07503, USA.
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Abstract
Endocarditis is a rare, but potentially fatal process in children. Patients with congenital heart disease compose the majority of patients with endocarditis. Neonates and children with central venous catheters are an increasingly frequent group of patients diagnose with this disease. Rheumatic fever predisposing to endocarditis is unusual. Streptococcus viridans and Staphylococcus aureus are the most pervasive organisms associated with endocarditis, though others are becoming more frequent. Blood cultures should be obtained in febrile children with congenital heart disease before the administration of antibiotics. Echocardiography is useful in children with known endocarditis, and in children in whom there is a high level of clinical suspicion for endocarditis. Echocardiography is a poor screening tool for patients without clinical or bacteriologic evidence for endocarditis. Endocarditis prophylaxis for children with congenital heart disease (excluding a secundum atrial septal defect) before appropriate procedures is recommended.
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Conway DS, Taylor AD, Burrell CJ. Atopic eczema and staphylococcal endocarditis: time to recognize an association? HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2000; 61:356-7. [PMID: 10953745 DOI: 10.12968/hosp.2000.61.5.1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 18-year-old man presented with a 3-day history of malaise, pyrexia, confusion and left knee pain. He had a history of atopic eczema since the age of 6 months but was otherwise well. He had worn a dental brace for the past 2 years without complications and had no recent dental intervention. There was no history of intravenous drug abuse. On examination he was pyrexial at 39.0°C, clinically dehydrated, with a sinus tachycardia of 100 beats per minute and a systemic blood pressure of 130/80 mmHg. He had eczematous lesions on his face, arms and legs. Auscultation revealed no cardiac murmurs and lung fields were clear. There were no stigmata of endocarditis. He was mentally obtunded with a Glasgow Coma Score of 14/15 but had no other neurological signs. The left knee demonstrated a full range of movement and no obvious effusion. Orthopaedic opinion was of a reactive arthritis. Chest and left knee radiography was unremarkable. C-reactive protein (CRP) was elevated at 251mg/litre, haemoglobin was 12.4g/dl, leukocytes 11.7×109/litre (with 89% neutrophils) and platelets 26×109/litre. A screen for disseminated intravascular coagulopathy was negative. He was hyponatraemic (sodium 125 mmol/litre) and mildly uraemic (urea 7.8 mmol/litre, creatinine 91μmol/litre). Blood cultures grew Staphylococcus aureus sensitive to flucloxacillin and gentamicin. Computed tomography (CT) of the brain showed generalized cerebral swelling with effacement of the basal cisterns, but no focal abnormality. Treatment was initiated with intravenous flucloxacillin, gentamicin and fluid replacement. The following day he developed severe pulmonary oedema and haemodynamic compromise necessitating admission to the intensive care unit for inotropic support and ventilation. Urgent transoesophageal echocardiography showed a 2x2 cm vegetation on the anterior mitral valve leaflet (Figure 1) with marked prolapse and severe mitral regurgitation. There was systolic flow reversal in the pulmonary veins. Left atrial size was normal and left ventricular function good. He underwent emergency mitral valve replacement with a St Jude mechanical valve (St Jude Medical Inc, St Paul, Minnesota, USA). At operation there was seen to be almost complete destruction of the anterior mitral valve leaflet. His postoperative recovery was good, completing 6 weeks of antibiotic therapy, and repeat CT showed resolution of the cerebral oedema. During the admission he experienced an exacerbation of his eczema and was treated with topical steroids and emollients by the dermatologists.
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Affiliation(s)
- D S Conway
- Department of Cardiology, Derriford Hospital, Plymouth
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Brydie AD, Clark AL. The changing face of endocarditis: report of a series of cases. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 1999; 60:378-80. [PMID: 10396418 DOI: 10.12968/hosp.1999.60.5.1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 67-year-old man presented with a sudden onset right homonymous hemianopia associated with a swinging pyrexia and a new early diastolic parasternal murmur. He had had a Bjork–Shiley aortic valve replacement 2 years previously for symptomatic aortic stenosis with a transvalvular gradient of 80 mmHg and had been well thereafter. Computed tomography scan of the brain showed a left occipital infarct (Figure 1), C-reactive protein was 51 mg/litre (normal <10 mg/litre), blood cultures consistently grew Candida parafilaris, and treatment with intravenous liposomal amphotericin and flucytocine was started the day the first positive culture was obtained. Transoesophageal echocardiography did not demonstrate vegetations, but did show a periprosthetic aortic incompetent leak. On day 11 the aortic prosthesis was removed and replaced because of worsening aortic incompetence. Direct inspection of the prosthesis demonstrated a vegetation on the sewing ring. The immediate postoperative recovery period was complicated by complete heart block requiring insertion of a permanent pacemaker after an initial phase of pericardial pacing. The intravenous antifungals were discontinued after 37 days of treatment and the patient commenced on lifelong oral fluconazole. At discharge on day 42 the patient was well and apyrexial with C-reactive protein less than 10 mg/litre.
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Affiliation(s)
- A D Brydie
- Department of Radiology, Glasgow Royal Infirmary
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Shkrum M, Wilson T. Infective Endocarditis—An Uncommon Cause of Unexpected Death. CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 1999. [DOI: 10.1080/00085030.1999.10757493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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