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Infective endocarditis in adults with congenital heart disease: is it time to change our approach to prophylaxis based on new insights into risk prediction?

Helmut Baumgartner
DOI: http://dx.doi.org/10.1093/eurheartj/ehr037 1835-1837 First published online: 23 February 2011

This editorial refers to ‘Turning 18 with congenital heart disease: prediction of infective endocarditis based on a large population’, by C.L. Verheugt et al., on page 1926

Infective endocarditis (IE) has remained a serious problem in cardiology as neither the incidence nor the mortality of this disease has decreased over the last decades.1 Despite major diagnostic and therapeutic advances, prognosis has remained poor and mortality high.2 The epidemiological profile of IE has changed over the years, particularly in industrialized countries.1 Whereas younger patients with previously known, mostly rheumatic valve disease were primarily affected in the past, the number of older patients who more often develop IE as the result of healthcare-associated procedures with either no previously known valve disease or with degenerative disease with or without valve replacement has now dramatically increased.3,4 Within the group of younger patients the epidemiological profile has also changed. While affected patients frequently had rheumatic valve disease in the past, congenital heart disease (CHD) is now predominating.2 The population of adults with CHD, on the other hand, has markedly increased over the past decades and is currently estimated at >1.2 million in Europe.5 Despite major advances in the medical care of these patients, a variety of possible complications remain frequent during long-term follow-up.6,7 IE is one of the most serious events in this population (Figure 1).8 The incidence of IE ranges from 3 to 10 episodes/100 000 person-years in the general population.2,3 The proportion of CHD in patients with IE has been reported to be between 2 and 18%,9– …