Endocarditis in children and adolescents with congenital heart defects: a Norwegian nationwide register-based cohort study.

OBJECTIVES: Congenital heart defects (CHD) are the most common birth defects worldwide and are an important cause of morbidity and early death. A significant number of deaths occur among patients with infections. CHDs predispose to the development of infective endocarditis (IE) and represent a risk factor for increased mortality due to IE. The aim of this study was to investigate the occurrence and outcomes of IE in children and adolescents with CHDs. METHODS: Data on all children with CHD and IE born in Norway between 1994 and 2016 were retrieved from the Oslo University Hospital's Clinical Registry for Congenital Heart Defects. Survivors were followed through 2016, and supplementary information was retrieved from medical records. RESULTS: In this nationwide register-based cohort study, which included all 1 357 543 live births in Norway between 1994 and 2016, the incidence of IE according to the European Society of Cardiology diagnostic criteria was 2.2 per 10 000 person-years among children and adolescents with CHDs. The incidence was stable throughout the period. Most patients with IE had severe CHDs (75%) and had undergone open chest cardiac surgery or catheter-based cardiac interventions the last year before IE. IE-related mortality among children with CHDs and IE was 8% during the follow-up period (mean 12.4 years (±5.5 years)). CONCLUSIONS: The incidence of IE among children and adolescents with CHDs was higher than the reported incidence in the general population. IE was associated with severe CHDs and recent complex cardiac interventions, and had significant mortality.

Out-of-hospital sudden cardiac arrest in children with congenital heart defects.

AIMS: Out-of-hospital sudden cardiac arrest (SCA) is a rare but devastating event in children and adolescents. The risk is assumed to be higher in children with congenital heart defects (CHDs) than in healthy individuals. The aim of the present study was to investigate the rate of and survival after out-of-hospital cardiac arrest in children 2-18 years old with CHDs. METHODS AND RESULTS: Data concerning all live births in Norway between 1994 and 2009 were retrieved from the Medical Birth Registry of Norway, the patient administrative systems at all hospitals in Norway, the Oslo University Hospital's Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and supplementary information for the deceased children was retrieved from medical records at Norwegian hospitals. Among the 943 871 live births in Norway from 1994 to 2009, 11 272 (1.2%) children had a CHD. We identified 11 (0.1%) children 2-18 years old with CHDs who experienced out-of-hospital SCA. The estimated rate of out-of-hospital SCA in children 2-18 years old with CHD was 10 per 100 000 person-years. Early cardiopulmonary resuscitation was initiated in all patients. Three children survived. CONCLUSIONS: The incidence of and survival after out-of-hospital SCA in children with CHDs were comparable to the reported rates in the general child population.

Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase?

The number of patients with grown-up congenital heart (GUCH) disease is steadily increasing. Although there is agreement that the medical service for GUCH patients should be expanded in coming years, it is still unknown whether this should also include the surgical service. In an attempt to elucidate this we reviewed our population of surgical GUCH patients (n=225) operated in our institution from 1998 to 2005. The patients' charts were reviewed. For details of the procedures, the hospital's internal database (PATS) was used. Patients were stratified according to diagnosis and complexity of the surgical procedures in a simple, moderate and complex category group. The yearly number of operations remained stable in the period. However, whereas the size of the simple complexity group was reduced in the study period, the size of both the moderate and the complex category groups increased progressively. Forty-four percent of the surgical procedures were reoperations. Morbidity and mortality (1.3%) were low. The present study suggests that the future surgical GUCH patients will be increasingly complex. However, it is speculative whether the total number of surgical GUCH patients will increase. This is especially explained by the continuous introduction of new percutaneous catheter techniques.