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**44**

**47**

**Chapter 3**

**Abstract**

bronchiolitis

**1. Introduction**

adulthood [1].

without CHD [2].

experience critical illness from RSV LRTI.

hemodynamically significant.

Respiratory Syncytial Virus

Congenital Heart Disease

*Maja Daurach and Ina Michel-Behnke*

Infections among Children with

Infants and children suffering from congenital heart disease represent a patient cohort particularly at risk for severe RSV infections. Most notably the complication rates in lower respiratory tract infections due to RSV among patients with congenital heart disease are significantly higher compared to other patient collectives. Predisposing factors are altered lung mechanics caused by either increased or decreased pulmonary blood flow, both resulting in a ventilation/ perfusion mismatch causing decreased pulmonary compliance and higher airway resistance. Randomized controlled trials have shown that immunoprophylaxis with palivizumab is beneficial for CHD patients. Guidelines from different national societies suggest administration of palivizumab for infants with CHD in young age injected monthly throughout the RSV season, if the CHD is considered

**Keywords:** congenital heart disease (CHD), respiratory syncytial virus (RSV), palivizumab, immunoprophylaxis, lower respiratory tract infection (LRTI),

the other end of the spectrum, children suffer from serious complications and negative impact with chronic respiratory problems that can persist into

Since the 1980s infants and young children with congenital heart defects (CHD) have been shown to be a particularly vulnerable population developing severe lower respiratory tract infections (LRTIs) caused by RSV. The severity of infections in children with CHD was significantly higher than severity in children

ing RSV infections in children with CHD. In particular, we try to elucidate the mechanisms for the susceptibility of children with congenital heart defects to

This chapter will provide an overview of the current state of knowledge regard-

The burden of respiratory syncytial virus (RSV) infections differs markedly between patients. Clinical symptoms might be mild as in a common cold, while at
