In the last review of IE prophylaxis, the conditions the Table 10. Clinical Situations Constituting High Risk for Complications of IE Prosthetic cardiac valves Left-sided IE Staphylococcus aureus IE Fungal IE Previous IE Prolonged clinical symptoms (>3 mo) Cyanotic congenital heart disease Patients with systemic-to-pulmonary shunts Poor clinical response to antimicrobial therapy IE indicates infective endocarditis. Reprinted from Bayer et al.102 Copyright 1998, American Heart Association, Inc. AHA recommended as highest risk for adverse outcomes from IE and for which prophylaxis before high-risk dental procedures is reasonable included cardiac valve repair with a prosthetic valve or prosthetic material; previous IE; cer- tain CHD (unrepaired cyanotic CHD, repaired CHD with prosthetic material or device during the first 6 months after the procedure, repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device); and recipients of cardiac transplants who develop Finally, as growing numbers of children successfully tran- sition to adult-based healthcare circumstances, carrying their complex cardiovascular histories with them, the issues sur- rounding IE prevention will continually be reiterated as part of their healthcare maintenance program. Recommendation 1. Children with cyanosis may have specific periodon- tal concerns, which makes optimum oral hygiene particularly important for them. The AHA recom- mends that for those in the highest-risk groups, prophylactic antibiotic drugs before certain dental procedures may be considered3 (Class IIb; Level of Evidence C). Table 11. 