Cor Vasa 2005, 46(11):417-421
Surgical treatment of infectious endocarditis in children and adolescents
- Dětské kardiocentrum, Fakultní nemocnice Motol a Centrum výzkumu chorob srdce a cév, Praha, Česká republika
Aim:
To evaluate results of surgical treatment of infectious endocarditis (IE) in childhood.
Methods:
A retrospective study of 49 patients (30 boys, 19 girls) undergoing surgery for IE at age two weeks to 21 years (median 10.6 years) in the Pediatric Heart Center over the years 1978 to 2004.
Results:
A total of 41 patients (84%) were on follow-up because of congenital heart disease (CHD); 20 had native CHD
whereas 21 had undergone cardiac surgery. The most common CHDs included ventricular defect (55%) and mitral valve prolapse (20%).
The predominant pathogens in the etiology of IE included staphylococci (53%) and streptococci (27%), with negative IE
cultures in 10%. The most common indication for surgery was embolism, infected foreign material, and heart failure. All patients undergoing surgery had the infectious material removed; 92% of children had another cardiac surgical procedure. Re-do surgery was indicated in 8% of patients because of recurrence. Early post-operative deaths included three (6.1%)
patients, with late death possibly related to IE occurring in five (10.2%) patients.
Conclusion:
Pediatric IE is a serious disease with high mortality rates, which can be reduced by surgery. Surgery is indicated following pretreatment of the patient with intravenous antibiotics. Closure of hemodynamically less significant
ventricular septal defects in pre-school age has been suggested as prevention to development of IE.
Keywords: Infectious endocarditis; Congenital heart disease; Surgical management; Echocardiography
Published: November 1, 2005 Show citation