Critical Care Management of the ACHD Patient with Endocarditis

  • Laurence IserinEmail author
Part of the Congenital Heart Disease in Adolescents and Adults book series (CHDAA)


Infective endocarditis (IE) in adult congenital heart disease (ACHD) patients is a crucial issue. The risk of endocarditis is much higher in ACHD patients than in the general population (1.3 cases/10,000 person-years vs. 3–7 per 100,000 person-years, respectively). Nevertheless, compared to non-congenital population, its outcome is usually seen as less severe. Independent predictors of IE in this specific population are baseline valve-containing prosthetics, multiple defects, previous IE, and gender (lower incidence in females). As we focus on critical care on this review, every step of management from diagnosis to medical or surgical treatment can be different from the usual strategies addressed to non-ACHD patients admitted with endocarditis. The incidence of right-sided endocarditis is preeminent in this population and can explain the global lower mortality in these patients (still up to 16%).

Endocarditis in ACHD carries a significant risk of deterioration, either in left heart disease with the risk of neurologic complications or in obstructive forms of pulmonary endocarditis which can be rapidly life threatening on a previously stable patient.

Transesophageal echocardiography, viewed as the gold standard diagnostic tool in non-congenital patients, can be misleading especially in cyanotic disease and in right heart endocarditis. CT scanner is therefore becoming a useful tool in the diagnosis of endocarditis for ACHD patients. Timing of surgery, if necessary, is difficult to define, in multi-operated patients with comorbidities. Postoperative course is threatened by renal or heart failure. For all these reasons, international guidelines recommend a specialized team approach to comprehensively manage IE in ACHD patients, especially when complex and/or with multi-organ involvement.


Endocarditis Congenital heart disease Cardiac imaging Valve disease Echocardiography Prognosis Guidelines Infection Nuclear imaging Congenital cardiac surgery Cardiac device Prosthetic heart valves Prophylaxis 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.ACHD Unit, Cardiology Department and M3C center of reference for complex congenital defectsHôpital Européen Georges PompidouParisFrance

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