Endocarditis in Adults with Congenital Heart Disease

Infective endocarditis (IE) remains a major cause of morbidity and mortality in patients with congenital heart disease (CHD). Advances in medical and surgical care have led to a growing population of adults with CHD who carry a substantially higher lifetime risk of IE than the general population. This increased susceptibility reflects the combined effects of abnormal intracardiac flow patterns, the frequent presence of prosthetic material or intracardiac devices, and repeated surgical and transcatheter interventions. The epidemiology, microbiology, clinical presentation, and management of IE in CHD differ in several important aspects from those observed in patients without CHD. Streptococcal species and Staphylococcus aureus account for the majority of IE cases. Diagnosis is often challenging due to complex cardiac anatomy and the presence of prosthetic material, and therefore it requires a high index of suspicion and multimodality imaging. Medical therapy usually requires prolonged antimicrobial therapy. Surgical intervention is more frequently required than in non-CHD populations, reflecting both the burden of prosthetic material and the higher rate of complications at presentation. Preventive strategies, including meticulous dental and skin hygiene and appropriate antibiotic prophylaxis, remain the cornerstone of IE management in this high-risk population.