Endocarditis infecciosa en adultos con cardiopatía congénita. Experiencia en un centro de referencia / Infective endocarditis in adult patients with congenital heart disease. Experience from a reference centre

INTRODUCCIÓN: Cada vez más pacientes con cardiopatía congénita alcanzan la edad adulta. Una complicación que pueden presentar es la endocarditis infecciosa (EI). Nuestro objetivo es describir las características de la EI en esta población en un centro de referencia. MÉTODOS: Estudio retrospectivo de una cohorte de pacientes mayores de 16 años afectos de una cardiopatía congénita diagnosticados de EI (definida por los criterios modificados de Duke) entre 1996 y 2014. Para el análisis descriptivo se consideró el primer episodio de cada paciente. RESULTADOS: Durante el periodo de estudio se incluyeron 27 pacientes con EI. Presentaban una edad mediana al diagnóstico de 27,7 años, predominio masculino (63%) y baja comorbilidad (índice de Charlson 0 de mediana). La adquisición fue mayoritariamente comunitaria (78%). La comunicación interventricular fue la cardiopatía subyacente más frecuente (33%). El 48% de los pacientes estaban reparados y el 19% paliados. El 41% de los pacientes eran portadores de material protésico. El 81% presentaban algún tipo de defecto residual. El 44% fueron endocarditis sobre cavidades derechas. Los microorganismos más frecuentes fueron estreptococos del grupo viridans (41%) y Staphylococcus epidermidis (30%). Un 37% requirió tratamiento quirúrgico. Hubo 5 reinfecciones y 3 recidivas. Dos pacientes fallecieron, ambos a consecuencia de una recidiva. CONCLUSIONES: La EI en adultos con cardiopatía congénita ocurrió en pacientes jóvenes, casi siempre con material protésico o lesiones residuales y con frecuencia en cavidades derechas. Aunque en muchos casos requirió tratamiento quirúrgico la mortalidad fue baja, excepto en el caso de las recidivas

INTRODUCTION: A growing number of patients with congenital heart disease (CHD) will reach adulthood. Infective endocarditis (IE) is a major complication in this population. The aim of this study was to describe the features of IE in adults with CHD treated in a reference centre. METHODS: A retrospective review was performed on a cohort of patients over 16 years of age with CHD who presented with IE (defined by the modified Duke criteria) between 1996 and 2014. Only the first episode from each patient was considered for the descriptive analysis. RESULTS: IE was observed in 27 patients. The median age at diagnosis of IE was 27.7 years, and 63% were male. Comorbidity was low (median Charlson index was 0). IE was mostly community-acquired (78%). The most frequent CHD were ventricular septal defect (33%). A repair was performed in 48% of patients, and 19% received palliative treatment. Forty-one percent of patients had some type of prosthesis. A residual defect was observed in 81%. The IE was detected in the right side of 44% of the patients. The most frequent aetiological agents were viridans group streptococci (41%) and Staphylococcus epidermidis (30%). Surgery was required to treat IE in 37% of patients. There were five re-infections and three relapses. Two patients died, both as a result of recurrence. CONCLUSIONS: IE in adults with CHD occurred in young patients, and almost all of them carried some prosthetic material or a residual defect. The IE is frequently right-sided. Although surgical treatment was required in many cases, mortality was low, except in the case of relapses

[Infective endocarditis in adult patients with congenital heart disease. Experience from a reference centre]. / Endocarditis infecciosa en adultos con cardiopatía congénita. Experiencia en un centro de referencia.

INTRODUCTION: A growing number of patients with congenital heart disease (CHD) will reach adulthood. Infective endocarditis (IE) is a major complication in this population. The aim of this study was to describe the features of IE in adults with CHD treated in a reference centre. METHODS: A retrospective review was performed on a cohort of patients over 16 years of age with CHD who presented with IE (defined by the modified Duke criteria) between 1996 and 2014. Only the first episode from each patient was considered for the descriptive analysis. RESULTS: IE was observed in 27 patients. The median age at diagnosis of IE was 27.7 years, and 63% were male. Comorbidity was low (median Charlson index was 0). IE was mostly community-acquired (78%). The most frequent CHD were ventricular septal defect (33%). A repair was performed in 48% of patients, and 19% received palliative treatment. Forty-one percent of patients had some type of prosthesis. A residual defect was observed in 81%. The IE was detected in the right side of 44% of the patients. The most frequent aetiological agents were viridans group streptococci (41%) and Staphylococcus epidermidis (30%). Surgery was required to treat IE in 37% of patients. There were five re-infections and three relapses. Two patients died, both as a result of recurrence. CONCLUSIONS: IE in adults with CHD occurred in young patients, and almost all of them carried some prosthetic material or a residual defect. The IE is frequently right-sided. Although surgical treatment was required in many cases, mortality was low, except in the case of relapses.

"Pulmonary valve replacement diminishes the presence of restrictive physiology and reduces atrial volumes": a prospective study in Tetralogy of Fallot patients.

Pulmonary valve replacement (PVR) reduces right ventricular (RV) volumes in the setting of long-term pulmonary regurgitation after Tetralogy of Fallot (ToF) repair; however, little is known of its effect on RV diastolic function. Right atrial volumes may reflect the burden of RV diastolic dysfunction. The objective of this paper is to evaluate the clinical, echocardiographic, biochemical and cardiac magnetic resonance (CMR) variables, focusing particularly on right atrial response and right ventricular diastolic function prior to and after elective PVR in adult patients with ToF. This prospective study was conducted from January 2009 to April 2013 in consecutive patients > 18 years of age who had undergone ToF repair in childhood and were accepted for elective PVR. Twenty patients (mean age: 35 years; 70% men) agreed to enter the study. PVR was performed with a bioporcine prosthesis. Concomitant RV reduction was performed in all cases when technically possible. Pulmonary end-diastolic forward flow (EDFF) decreased significantly from 5.4 ml/m(2) to 0.3 ml/m(2) (p < 0.00001), and right atrial four-chamber echocardiographic measurements and volumes by 25% (p = 0.0024): mean indexed diastolic/systolic atrial volumes prior to surgery were 43 ml/m(2) (SD+/-4.6)/63 ml/m(2) (SD+/-5.5), and dropped to 33 ml/m(2) (SD+/-3)/46 ml/m(2) (SD+/-2.55) post-surgery. All patients presented right ventricular diastolic and systolic volume reductions, with a mean volume reduction of 35% (p < 0.00001). Right ventricular diastolic dysfunction was common in a population of severely dilated RV patients long term after ToF repair. Right ventricular diastolic parameters improved as did right atrial volumes in keeping with the known reduction in RV volumes, after PVR.