Hindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 646780, 8 pages doi:10.1155/2012/646780 Review Article Managing the Morbidity Associated with Respiratory Viral Infections in Children with Congenital Heart Disease Joseph M. Geskey1 and Stephen E. Cyran2 1 Division of Pediatric Hospital Medicine, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA 2 Division of Pediatric Cardiology, Penn State College of Medicine, Hershey, PA 17033, USA Correspondence should be addressed to Joseph M. Geskey, jgeskey@hmc.psu.edu Received 1 August 2011; Accepted 24 December 2011 Academic Editor: Randall Fisher Copyright © 2012 J. M. Geskey and S. E. Cyran. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Children with congenital heart disease (CHD) are at risk for increased morbidity from viral lower respiratory tract infections because of anatomical cardiac lesions than can worsen an already compromised respiratory status. Respiratory syncytial virus (RSV) remains an important pathogen in contributing toward the morbidity in this population. Although the acute treatment of RSV largely remains supportive, the development of monoclonal antibodies, such as palivuzumab, has reduced the RSV-related hospitalization rate in children with CHD. This review highlights the speciﬁc cardiac complications of RSV infection, the acute treatment of bronchiolitis in patients with CHD, and the search for new therapies against RSV, including an eﬀective vaccine, because of the high cost associated with immunoprophylaxis and its lack of reducing RSV-related mortality. 1. Introduction Surgical outcomes in children with congenital heart disease (CHD) have improved over the past two decades because of advances in prenatal diagnosis, surgical and cardiopul- monary bypass techniques, and postoperative management [1]. In fact, it is expected that adult patients with CHD now exceed the number of children with CHD [2], and the majority of patients who have undergone surgical correction for their CHD do not consider their quality of life to be impacted by their malformation [3]. These improved outcomes require a signiﬁcant economic investment so that processes of care are optimally aligned throughout the continuum of a patient’s life from initial diagnosis, through his or her surgical correction (including postoperative management) and after hospitalization follow- up. However, a signiﬁcant number of these children will require multiple surgeries before they are fully corrected and, therefore, can be exposed to community-acquired respira- tory infections which can result in substantial morbidity and mortality. Outside the perioperative period, respiratory infections are signiﬁcantly more likely to be the cause of death during the winter than the summer [4]. Consequently, it is critical for both primary care physicians and pediatric cardiologists to remain familiar with the current epidemi- ology and clinical management of respiratory pathogens in children with CHD, while also understanding what contem- porary prophylactic options exist in minimizing the burden of viral respiratory infections throughout this population. Over one-half of hospital admissions related to acute respiratory tract infections in children with CHD are due to bronchiolitis [5]. In the United States, the number of out- patient visits and the number and percentage of yearly hos- pitalizations for bronchiolitis have actually increased since 1980 [6, 7]. Respiratory syncytial virus (RSV) remains the most common etiologic agent of bronchiolitis and is respon- sible for up to 90% of hospitalizations due to bronchiolitis [8]. Children with CHD have higher rates of hospitalization, a longer length of stay, and risk of death if they become infected with RSV compared to children without CHD [9–11]. It is estimated that there are 33.8 million episodes of RSV lower respiratory tract infection (LRTI) worldwide, with children in developing countries twice as likely to be infected