Bacterial Endocarditis

Bacterial endocarditis is an infection of the lining of the heart. It occurs when bacteria (germs) enter the bloodstream and lodge inside the heart, where they multiply and cause infection.

Although anyone can get bacterial endocarditis, those with a congenital heart defect may have a higher risk. This is because people with congenital heart disease may have a rough area on the heart lining, caused by a leaky or narrow valve, abnormal connections inside the heart, or previous surgery. These rough areas or materials placed from a previous surgery or catheter procedure are potential places for bacteria to take hold and multiply.

Bacterial endocarditis does not occur very often, but when it does, it can cause serious heart damage and is potentially life threatening.

The most common sign of bacterial endocarditis in children with a congenital heart defect is a fever that occurs after a procedure in the mouth, intestinal tract, or urinary tract. In some cases, the infection may occur without a procedure.

Other symptoms may include:

• Poor appetite
• Fatigue
• Joint pain
• Rash
• Weight loss

Bacterial endocarditis can occur when bacteria enter the body and grow on the heart lining. In children and adults with congenital heart disease, this can happen during one of the following procedures:

• Dental procedures (including teeth cleaning)
• Surgery to remove tonsils or adenoids (tonsillectomy or adenoidectomy)
• Examination of the respiratory passageways with an instrument known as a rigid bronchoscope
• Certain types of surgery on the respiratory passageways, the gastrointestinal tract, or the urinary tract
• Gallbladder or prostate surgery

Bacterial endocarditis is usually diagnosed with a blood test. Other tests might include:

• Blood test
• Echocardiogram (cardiac ultrasound)
• Cardiac magnetic resonance imaging (MRI)

There are ways to help prevent bacterial endocarditis in children and adults with congenital heart defects:

• Maintain excellent oral hygiene, including regular brushing and flossing, and have regular visits to the dentist for professional cleaning and check-ups.
• Taking an oral antibiotic before any procedure that could put the person at risk for this infection.
• Follow your cardiologist recommendations before any procedures.

In many cases, the infection can be treated with strong antibiotics given through an IV over the course of several weeks. But because bacterial endocarditis may cause severe damage to the heart lining and heart valves before the infection can be controlled, some patients may require surgery.

Here at the Boston Children’s Hospital Benderson Family Heart Center, our expert team provides inpatient and outpatient care for patients with congenital heart disease. The treatment for bacterial endocarditis is both medical and surgical, and requires a coordinated team of clinicians from various specialties to ensure the most successful outcome. When surgery is required for valve infection, our surgeons specialize in valve repair and avoiding replacement whenever possible. We repair valves that are traditionally repaired at other centers.