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
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