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Original article
High incidence of infective endocarditis in adults with congenital ventricular septal defect
  1. Elisabeth Berglund1,
  2. Bengt Johansson1,
  3. Mikael Dellborg2,
  4. Peder Sörensson3,
  5. Christina Christersson4,
  6. Niels-Eric Nielsen5,
  7. Daniel Rinnström1,
  8. Ulf Thilén6
  1. 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  2. 2Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Clinical Sciences, Uppsala University, Uppsala, Sweden
  5. 5Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  6. 6Department of Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
  1. Correspondence to Dr Bengt Johansson, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden; bengt.johansson{at}umu.se

Abstract

Objective Ventricular septal defects (VSDs), if haemodynamically important, are closed whereas small shunts are left without intervention. The long-term prognosis in congenital VSD is good but patients are still at risk for long-term complications. The aim of this study was to clarify the incidence of infective endocarditis (IE) in adults with VSD.

Methods The Swedish registry for congenital heart disease (SWEDCON) was searched for adults with VSD. 779 patients were identified, 531 with small shunts and 248 who had the VSD previously closed. The National Patient Register was then searched for hospitalisations due to IE in adults during a 10-year period.

Results Sixteen (2%) patients were treated for IE, 6 men and 10 women, with a mean age of 46.3±12.2 years. The incidence of IE was 1.7–2.7/1000 years in patients without previous intervention, 20–30 times the risk in the general population. Thirteen had small shunts without previous intervention. There was no mortality in these 13 cases. Two patients had undergone repair of their VSD and also aortic valve replacement before the episode of endocarditis and a third patient with repaired VSD had a bicuspid aortic valve, all of these three patients needed reoperation because of their IE and one patient died. No patient with isolated and operated VSD was diagnosed with IE.

Conclusions A small unoperated VSD in adults carries a substantially increased risk of IE but is associated with a low risk of mortality.

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Footnotes

  • Contributors EB: Planning of study, data collection, establishing of database, analysis of data and drafting of manuscript. BJ: Planning of study, data collection, analysis of data and drafting of manuscript. MD, PS, CC and N-EN: Planning of study, data collection, critical revision and approving of manuscript. DR: Planning of study, analysis of data, critical revision and approving of manuscript. UT: Planning of study, data collection and drafting of manuscript.

  • Funding This study was supported by the Swedish Heart-Lung Foundation (Project grant 2014–2017), Umeå University and the county councils of Västerbotten and Västernorrland.

  • Competing interests None declared.

  • Ethics approval Regional Ethics Board, Umeå University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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