Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-08T20:14:02.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Results of surgical treatment for infective endocarditis in children

Published online by Cambridge University Press:  18 November 2005

Turkan Tansel ,
Ertan Onursal ,
Rukiye Eker ,
Turkan Ertugrul  and
Enver Dayioglu
Turkan Tansel
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
Ertan Onursal
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
Rukiye Eker
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
Turkan Ertugrul
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
Enver Dayioglu
Affiliation:
Departments of Cardiovascular Surgery and Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Infective endocarditis is uncommon condition, with a high degree of morbidity and mortality. It is less common in children, albeit tending to be associated with congenital cardiac malformations. We describe our experience of the need for surgical treatment in children with infective endocarditis. Patients and methods: We analyzed retrospectively the records of 9 children aged below 16 years seen between May 2003 and March 2005 with infective endocarditis, reviewing the demographic details, clinical presentation, microbiological and echocardiographic data, operative findings, and outcome. Results: Apart from pre-existing renal insufficiency in 1 patient, congenital cardiac malformations were the predisposing factors. Blood cultures were positive in 3, but remained negative in the other 6 patients. The indications for surgical treatment included uncontrolled sepsis, congestive heart failure, recurrent endocarditis, patch or graft dehiscence, and pseudoaneursymal formation. Death due to uncontrolled sepsis resulting in multiorgan failure occurred in 1 patient, who had tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. Another patient died late postoperatively due to cardiac failure after relapse of the endocarditis in the setting of negative blood cultures. Conclusion: Despite advances in antimicrobial therapy, diagnosis, and measures of treatment for infective endocarditis, complications continue to be responsible for substantial morbidity and mortality. Since blood cultures are frequently negative, clinical and echocardiographic findings should be the major determinants of strategies used for treatment. We believe that our small series of patients seen over the past two years in which surgical treatment was performed will be helpful in guiding the clinical perspectives for children with infective endocarditis.

Keywords

Congenital heart failureinfective endocarditischildrencardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 6 , December 2005 , pp. 621 - 626
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Castillo JC, Anquita MP, Ramirez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study. Heart 2000; 83: 525–530.Google Scholar
Loupa C, Mentzikof DG. Current opinions in infective endocarditis. Hellenic J Cardiol 2002; 43: 53–62.Google Scholar
Humpl T, McCrindle BW, Smallhorn JF. The relative roles of transthoracic compared with transeosophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol 2003; 41: 2068–2071.Google Scholar
Ferrieri P, Gewitz MH, Gerber MA, et al. Unique features of infective endocarditis in childhood. Pediatrics 2002; 109: 931–943.Google Scholar
Fisher MC. Changing risk factors for pediatric infective endocarditis. Curr Infect Dis Resp 2001; 3: 333–336.Google Scholar
Garg N, Kandpal B, Garg N, et al. Characteristics of infective endocarditis in a developing country – clinical profile and outcome in 192 Indian patients, 1992–2001. Int J Cardiol 2005; 98: 253–260.Google Scholar
Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30: 633–638.Google Scholar
Sadiq M, Latif F, ur-Rahman A. Analysis of infective endocarditis in patent ductus arteriosus. Am J Cardiol 2004; 93: 513–515.Google Scholar
Netzer RO-M, Zollinger E, Seiler C, Cerny A. infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980–1995. Heart 2000; 84: 25–30.Google Scholar
Naber CK, Erbel R. Diagnosis of culture negative endocarditis: novel strategies to prove the suspect guilty. Heart 2003; 89: 241–243.Google Scholar
Kavey REW, Frank DM, Byrum CJ, Blackman MS, Sondheimer HM, Bowe EL. Two-dimensional echocardiographic assessment of infective endocarditis in children. Am J Dis Child 1983; 137: 851–856.Google Scholar
Valente AM, Jain R, Scheurer M, et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115: e15–e19.Google Scholar
Niwa K, Nakazawa M, Miyatake K, Tateno S, Yoshinaga M. Survey of prophylaxis and management of infective endocarditis in patients with congenital heart disease – Japanese Nationwide Survey. Circ J 2003; 67: 585–591.Google Scholar
Saiman L, Prince A, Gerony WM. Pediatric infective endocarditis in the modern era. J Ped 1993; 122: 847–853.Google Scholar
Grijalva M, Horvath R, Dendis M, Erny J, Benedik J. Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients. Heart 2003; 89: 263–268.Google Scholar
Bonow R, Carabello B, de Leon A, et al. Guidelines for the management of patients with valvular disease. ACC/AHA Practice Guidelines, executive summary. Circulation 1998; 98: 1949–1984.Google Scholar
Cabell CH, Wang A. Current treatment options for patients with endocarditis: the evolving indication for cardiac surgery. Curr Treat Options Cardiovasc Med 2004; 6: 441–449.Google Scholar
Sanders GP, Yeon SB, Grunes J, Seto TB, Manning WJ. Impact of a specific echocardiographic report comment regarding endocarditis prophylaxis on compliance with American Heart Association Recommendations. Circulation 2002; 106: 300–303.Google Scholar
Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation 1997; 96: 358–366.Google Scholar
Durack DT. Prevention of infective endocarditis. N Engl J Med 1995; 332: 38–44.Google Scholar
Awadallah SM, Kavey R-EW, Byrum CJ, Smith FC, Kveselis DA, Blackman MS. The changing pattern of infective endocarditis in childhood. Am J Cardiol 1991; 68: 90–94.Google Scholar
Liew WK, Tan TH, Wong KY. Infective endocarditis in childhood: a seven-year experience. Singapore Med J 2004; 45: 525–529.Google Scholar