312 Infective endocarditis in adults with congenital heart disease

The aim of this retrospective study was to describe features ofinfective endocarditis (IE) in adults with congenital heart disease (CHD). Methods The records of all episodes of IE diagnosed from 1974, in patients with CHD and more than 18 years of age at diagnosis, were retrospectively reviewed. Results Fourty-four episodes of IE occurred, 36 after 1990 (81.8%), 28 males (63.6%). Age at diagnosis was 30.3±9years (median 28years). Ten were recurrent episodes (22.7%). CHD was previously repared in 15 cases (34%), palliated in 7 (16%) and non-operated in 22 (50%). Dental causes were predominant (34%), followed by cutaneous causes (25%) ; others were postoperative (4.5%), miscellaneous (7%) or unknown causes (29.5%). A microbial agent as identified in 95.4% of the cases : oral streptococcus and staphylococcus aureus were the leading causative agents (respectively 41% and 36%). Left heart locations were predominant (75%). Severe clinical cardiac complication occurred in 10 cases (23%), an echocardiographic complication in 18 (40%). Twenty-four patients experienced embolic events (54.5%) ; early surgical treatment was required in 25% of the cases. Three patients died due to IE (6.8%). Antibiotic prophylaxis had been neglicted despite known risk in 41% of the cases. Conclusion IE is an ongoing life-threatening complication in adults with CHD, with a significant morbidity, a high rate of prophylaxis negligence and of recurrence.