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Cynthia D. Morris, PhD, MPH; Mark D. Reller, MD; Victor D. Menashe, MD

JAMA. 1998;279:599-603.

Context.— The incidence of infective endocarditis after surgical repair of congenital heart defects is unknown.

Objective.— To determine the long-term incidence of endocarditis after repair of any of 12 congenital heart defects in childhood.

Design.— Population-based registry started in 1982.

Setting.— State of Oregon.

Participants.— All Oregon residents who underwent surgical repair for 1 of 12 major congenital defects at the age of 18 years or younger from 1958 to the present.

Main Outcome Measure.— Diagnosis of infective endocarditis confirmed by hospital or autopsy records.

Results.— Follow-up data were obtained from 88% of this cohort of 3860 individuals through 1993. At 25 years after surgery, the cumulative incidence of infective endocarditis was 1.3% for tetralogy of Fallot, 2.7% for isolated ventricular septal defect, 3.5% for coarctation of the aorta, 13.3% for valvular aortic stenosis, and 2.8% for primum atrial septal defect. In the cohorts with shorter follow-up, at 20 years after surgery the cumulative incidence was 4.0% for dextrotransposition of the great arteries; at 10 years, the cumulative incidence was 1.1% for complete atrioventricular septal defect, 5.3% for pulmonary atresia with an intact ventricular septum, and 6.4% for pulmonary atresia with ventricular septal defect. No children with secundum atrial septal defect, patent ductus arteriosus, or pulmonic stenosis have had infective endocarditis after surgery.

Conclusion.— The continuing incidence of endocarditis after surgery for congenital heart defect, particularly valvular aortic stenosis, merits education about endocarditis prophylaxis for children and adults with repaired congenital heart defects.

From the Congenital Heart Disease Research Center (Drs Morris, Reller, and Menashe), Division of Medical Informatics and Outcomes Research (Dr Morris), Division of Pediatric Cardiology (Drs Reller and Menashe), Oregon Health Sciences University, Portland.

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