Lee Phong Teck, Uy Felix Maverick, Foo Jie Sheng, Tan Ju Le
National Heart Centre, Singapore.
Congenit Heart Dis. 2018 Nov;13(6):1005-1011. doi: 10.1111/chd.12667. Epub 2018 Sep 27.
Ventricular septal defect (VSD) is one of the most common congenital heart anomalies in childhood and there is an increasing prevalence of VSDs in the adult population. The long-term risk of infective endocarditis (IE) is of concern. The aim of this study was to clarify and compare the incidence of IE in adults with repaired and unrepaired VSDs.
Patients with VSDs were identified using the Adult Congenital Heart Disease registry at the National Heart Centre Singapore. Patients were divided into Group 1 (repaired VSD) and Group 2 (unrepaired VSDs). The electronic medical records were searched for hospitalization due to IE during a 10-year period (October 2, 2007-October 1, 2017).
Four hundred seventy-nine patients (53% male) were identified, with a mean age of 35.0 ± 13.7 years. There were 164 patients (34.2%) in Group 1 and 315 patients (65.8%) in Group 2. In total, there were eight episodes of IE from six patients (3 male, mean age of 42.2 ± 20.7 years). Two patients had recurrent IE. The overall incidence of IE was 1.67/1000 y, and this is 11-15-fold higher compared to general adult population. The incidence of IE in Group 2 was 1.90/1000 y. There were no IE cases in Group 1.
Patients with VSDs, especially if unrepaired, carry a substantially increased risk of IE compared to the general population.
室间隔缺损（VSD）是儿童期最常见的先天性心脏畸形之一，并且在成年人群中室间隔缺损的患病率呈上升趋势。感染性心内膜炎（IE）的长期风险令人担忧。本研究的目的是阐明并比较已修复和未修复室间隔缺损的成年人中感染性心内膜炎的发生率。
通过新加坡国家心脏中心的成人先天性心脏病登记处识别室间隔缺损患者。患者分为第1组（已修复室间隔缺损）和第2组（未修复室间隔缺损）。在10年期间（2007年10月2日至2017年10月1日）检索电子病历中因感染性心内膜炎住院的情况。
共识别出479例患者（53%为男性），平均年龄为35.0±13.7岁。第1组有164例患者（34.2%），第2组有315例患者（65.8%）。总共有6例患者发生了8次感染性心内膜炎发作（3例男性，平均年龄42.2±20.7岁）。2例患者发生了复发性感染性心内膜炎。感染性心内膜炎的总体发生率为1.67/1000人年，这比普通成年人群高11至15倍。第2组感染性心内膜炎的发生率为1.90/1000人年。第1组未出现感染性心内膜炎病例。
与普通人群相比，室间隔缺损患者，尤其是未修复的患者，感染性心内膜炎的风险大幅增加。
