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Endocarditis
Endocarditis is a dangerous infection of the endocardium, the lining of the inside of the heart's four chambers. Certain bacteria and other microorganisms that occasionally circulate in the blood may settle and multiply on the heart valves. Abnormal heart valves, where blood flow is turbulent, are especially vulnerable to this kind of infection. Although effective treatments are available, endocarditis can lead to permanent damage of the heart valves or even heart failure.
Most congenital heart defects are associated with increased susceptibility to endocarditis. Individuals at high risk include those who have had endocarditis before, had previous defects in their heart valves or have mechanical valves (such as for aortic valve stenosis, and individuals with complex heart abnormalities like single ventricles, tetralogy of Fallot, or transposition of the great arteries. People who have had surgery to construct systemic pulmonary shunts or conduits also are at high risk.
Endocarditis is diagnosed using a combination of blood culture and special echocardiogram. If a child or an adult with congenital heart disease has a fever that cannot be attributed to a specific infection like strep throat or an ear infection, endocarditis should be considered.
Treatment of endocarditis may require four to six weeks or more of intravenous antibiotics and may include surgery. Penicillin (amoxicillin/ampicillin) and gentamicin are the most commonly used antibiotics. Other antibiotics can be used as well: vancomycin, cephalosporin, clindamycin, or azithromycin. Although powerful antibiotics are available, treatment can be difficult and complications of endocarditis may occur. Therefore people with congenital heart disease should do all they can to minimize their risk of developing this infection.
Prevention entails taking antibiotics prophylactically, prior to dental, genitourinary, or gastrointestinal procedures, to minimize the circulation of the bacteria found in the mouth, upper respiratory tract, and intestinal tract in the blood. In some cases the antibiotics will be administered intravenously and may include follow-up doses after the procedure. In other situations, the antibiotics are taken orally, one hour before the procedure. Detailed information on endocarditis treatment can be found on the American Heart Association website.
It's important to note that most cases of endocarditis are not caused by and do not directly follow a dental procedure. More often, the endocarditis follows a minor gum injury or is caused by poor dental hygiene. Regular and comprehensive dental care is imperative for people with congenital heart disease.
This section includes information on procedures for which endocarditis procedures are recommended.
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