Defining endocarditis in congenital heart disease

Document Type



Internal Medicine


PURPOSE: Two-thirds of the world's population resides in the developing world. In developing regions such as south Asia
METHODS: Patients with CHD and endocarditis admitted to Aga Khan University between 1988–2001 were retrospectively studied.
Forty-eight patients with CHD had IE by Modified Duke's Criteria. Twenty-two (46%) patients were >16 years old. Uncorrected ventricular septal defect (33%), teratology of fallot (12.5%), atrial septal defect (6.3%), patent ductus arteriosus (5%), coarctation of aorta (5%) and congenital mitral valve disease (12.5%) were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (6.3%). Only 11 (22.9%) patients had a previous palliative or corrective surgery. Mean age at surgery was 4.6 +/- 3.5 years. Streptococci (33%), Staphylococcus epidermidus (8.4%) and pseudomonas spp. (4.2%) were the most common microorganisms. Twenty-two (45.8%) patients had culture negative endocarditis. Patients with cyanotic heart disease were more likely to have positive cultures (78% vs. 48.7%), renal failure (28% vs.8.3%) and thrombocytopenia (60% vs. 11.7%), although the first two failed to reach statistical significance. However, there were no differences in heart failure, need for surgery and mortality. Surgery was required in nine (18.7%) patients and 13 (27.1%) patients died. Patients with heart failure (p
CONCLUSION: In contrast to developed countries, IE in Pakistan complicates uncorrected left-to-right shunts or TOF. Complex cyanotic defects are underrepresented probably because they are usually incompatible with life when not corrected.