A602JACC April 1, 2014

Volume 63, Issue 12

Congenital Heart Disease

infectiVe enDOcarDitis PrOPhylaxis - current Practice amOngst PeDiatric carDiOlOgists: are we fOllOwing 2007 guiDelines?

Poster ContributionsHall CMonday, March 31, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Advanced Imaging and Practice Patterns in Pediatric and Congenital Heart DiseaseAbstract Category: 10. Congenital Heart Disease: PediatricPresentation Number: 1266-270

Authors: Nishant C. Shah, Neil Patel, Ronak Naik, Penn State Hershey Children’s Hospital, Hershey, PA, USA, University of Tennassee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN, USA

background: The indications for antibiotics prophylaxis for prevention of Infective endocarditis (IE) have been revised in 2007. A web-based, anonymous survey was conducted in 2013 to evaluate the current practice for IE prophylaxis amongst the pediatric cardiologists.

results: Total 302 responses were received. The lesions, for which significant level of non-agreement for IE prophylaxis exist, are shown in table 1. Most cardiologists indicated no prophylaxis in cases of clinically silent PDA (97%), small muscular ventricular septal defect (VSD) (95%) and bicuspid aortic valve without valvulopathy (94%). Despite current guidelines, IE prophylaxis is not recommended in “Post Glenn/hemiFontan procedure” and “VSD repair with residual shunt” by 35% and 32% respectively. 57% do not follow 2007 IE guidelines exclusively for various reasons including conservative approach (20%), patient/family’s unwillingness (13%) and lack of clarity in 2007 guidelines (12%). Only 33% discuss the importance of dental hygiene with patients who are at risk of IE regularly.

conclusion: Substantial amount of heterogeneity persists amongst pediatric cardiologists in recommending IE prophylaxis for certain cardiac lesions even after six years post new guidelines. More than half participants don’t follow 2007 guidelines exclusively in their practice. Proper dental hygiene counseling in high risk patients for IE needs to be optimized in current practice.

Table 1: Clinical scenario and IE prophylaxis

Clinical scenario IE prophylaxis recommended (%) IE prophylaxis not recommended (%)

Rheumatic heart disease (more than mild degree of valvular lesion) 53 47

Fontan palliation without fenestration 55 45

Ross procedure 45 55

Intravenous pacemaker lead in right ventricle and small VSD 44 56

> mild degree of valvular lesion in single ventricle 62 38

Residual Aortic valve lesion post repair 38 62

Pulmonary valve replacement surgery in TOF 62 38

Cardiac transplant recipient without valvulopathy 34 66

Residual Mitral valve lesion post repair 34 66