"Body modification: piercing and tattooing in congenital heart disease patients", decoration or disaster?-a narrative review

Objective: Tattoos and piercings are types of body art, which are gaining popularity over the last decades. An increasing number of adolescents and adults with congenital heart disease (CHD) have piercings or tattoos. This review will provide prudent information on the subject for affected patients and health care professionals caring for them. Background: Amongst others, local infections are a common complication in up to 20% of all piercings and isolated cases of systemic infections like endocarditis have been reported. Individuals with congenital heart disease are especially susceptible to endocarditis and prone to suffer severe health consequences from it. In terms of tattooing endocarditis is less common but the localization must be well considered as it might interfere with cardiovascular magnetic resonance imaging (CMR), which constitutes an important part of follow up investigations in these patients. Methods: This article is written as a commentary narrative review and will provide an update on the current literature and available data on common forms of body modification and the potential risks for patients with CHD. Conclusions: In order to best advise patients and their families, health care professionals must be aware of potential risks accompanying the implementation of body art. Neither the European nor the American guidelines for endocarditis prophylaxis address piercings and tattoos. To our knowledge, there are no clear recommendations concerning piercings and tattoos for adolescents and adults with CHD.