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Pediatric Cardiology

, Volume 40, Issue 3, pp 580–584 | Cite as

Urgent Surgical Treatment of Aortic Endocarditis in Infants and Children

  • Gabriel AmirEmail author
  • Georgy Frenkel
  • Amichay Rotstein
  • Elchanan Nachum
  • Elchanan Bruckheimer
  • Alexander Lowenthal
  • Tom Einbinder
  • Einat Birk
Original Article

Abstract

Infective endocarditis (IE) in the pediatric population can present as a life-threatening condition. Optimal timing for surgical intervention should consider surgical risks versus the risk of neurologic complications. We herein report our experience with this group of critically ill children. Retrospective analysis of patient charts of all patients who underwent urgent surgical treatment of aortic IE from 1994 to 2014 was performed. Nine patients with acute storming IE of the aortic valve or the ascending aorta were urgently operated (eight normal heart, one congenital aortic stenosis), age ranged from 8 weeks to 4.2 years. Causative organisms were Staphylococcus aureus (2), Staphylococcus coagulase negative (1), Kingella kingae (2), Streptococcus pneumoniae (2), or culture negative (2). Presenting symptoms other than hemodynamic instability were neurologic decompensation (5) coronary embolization (1) and cardiogenic shock due to scalded skin syndrome (1). CT and MRI demonstrated significant brain infarcts in four patients. Operations performed were the Ross operation (7) and ascending aortic reconstruction (2). There were no operative deaths. At a median follow-up of 6 years (range 2–196 months), all patients are alive and well. Re-intervention included homograft replacement (2) and transcatheter Melody valve implantation (1). At their last follow-up, the neo-aortic valve was functional in all patients with minimal regurgitation and all had full resolution of the neurological deficits. Urgent surgical treatment for aortic valve IE in infants is challenging. Although surgery is complex and pre-disposing conditions such as sepsis, neurologic and cardiac decompensations are prevalent, operative results are excellent and gradual and significant neurologic improvement was noted over time.

Keywords

Aortic endocarditis Pediatric Ross operation Ascending aortic reconstruction 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants and Informed Consent

This is a descriptive retrospective case series. This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Cardiac SurgerySchneider Children’s Medical Center of IsraelPetach TikvaIsrael
  2. 2.Department of Pediatric CardiologySchneider Children’s Medical Center of IsraelPetach TikvaIsrael
  3. 3.Department of Pediatric Intensive CareSchneider Children’s Medical Center of IsraelPetach TikvaIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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