Pediatric Heart Expert Forum
Small VSDs and Endocarditis
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Small VSDs and Endocarditis

What is the risk of developing endocarditis, when you have a small VSD? My daughter (1) has a small VSD and mild leak in her TV valve. I know they warned us to be diligent about dental hygiene, and to try not to expose her to people who have strep throat. But she's a baby and teething, and she chews on ANYTHING. Is that an increased risk for her, should we discourage her chewing on shared toys at daycare, etc...?

Also, what would the signs be, if she did develop it? I know a few of the signs include cough, fever etc... So how do you tell it apart from just a viral infection? Currently DD has had a cough and runny nose for 11 days and just developed a fever of 103 last night. Her heart was racing and her breathing was really shallow so we took her to ER, but at ER they said her lungs sounded clear, and both her breathing and heart came down some with Tylenol - should they have looked into it last night, or is the risk really mild?
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Dear MSHanson,

While not zero, the risk of endocarditis with a small ventricular septal defect (VSD) is quite low.  We do not have exact numbers for this.  And, as the American Heart Association has collated the data every 7-10 years, we have found that bacteremia (bacteria going through the bloodstream) is MUCH more common than we realized.  It happens when we chew, when we brush our teeth, and when we have a bowel movement.  Therefore, this is one of the major reasons that AHA significantly decreased the use of endocarditis prophylaxis in many types of heart disease.

Overall, appropriate oral hygiene is what will reduce her risk even further, with healthy teeth and gums.  Certainly trying to differentiate endocarditis from usual childhood infections can be nervewracking for parents.  However, patients with endocarditis are typically QUITE sick, and probably do not respond quickly to antipyretics and fluids.  This will just take some practice and discussion with your primary care provider to help you with this.
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