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Mitral Valve Endocarditis in a Pediatric Patient: When Is the Right Time to Intervene? A Case Report

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Abstract

Infective endocarditis (IE) is most often treated conservatively with medical management. There are no clear guidelines in the pediatric population for timing of surgical intervention. This is a case report of an 18-month-old male admitted to the hospital with IE. His workup showed a large vegetation on the mitral valve with evolving regurgitation caused by Kingella kingae, a HACEK group organism. Factors that led to consideration for early surgical intervention included the size of the vegetation (19 mm), the etiologic agent (K. kingae) described to be associated with a high rate of complications, the absence of neurologic complications, and the possibility for valve-sparing repair strategies. Following mitral valve repair, the patient made an uneventful recovery and he was discharged home within a week, to complete a course of antibiotics. Surgical intervention early in the disease course of IE can be a safe option and could pre-empt the development of embolic complications especially in the setting of very large vegetations and certain types of high-risk organisms. Additionally, early surgery allows for valve repair and could avoid valve replacement with its attendant risk of anticoagulation therapy and future surgery.

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References

  1. Khoo B, Buratto E, Fricke TA, Gelbart B, Brizard CP, Brink J, et al. Outcomes of surgery for infective endocarditis in children: a 30-year experience. J Thorac Cardiovasc Surg. 2019;158(5):1399–409. https://doi.org/10.1016/j.jtcvs.2019.06.024.

    Article  PubMed  Google Scholar 

  2. Stavi V, Brandstaetter E, Sagy I, Sapunar S, Nevzorov R, Bartal C, et al. Comparison of clinical characteristics and prognosis in patients with right- and left-sided infective endocarditis. Rambam Maimonides Med J. 2019;28:10(1). https://doi.org/10.5041/RMMJ.10338.

    Article  Google Scholar 

  3. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC): endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30:2369–413. https://doi.org/10.1093/eurheartj/ehp285.

    Article  PubMed  Google Scholar 

  4. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435–86. https://doi.org/10.1161/CIR.0000000000000296.

    Article  CAS  PubMed  Google Scholar 

  5. Liang F, Song B, Liu R, Yang L, Tang H, Li Y. Optimal timing for early surgery in infective endocarditis: a meta-analysis. Interact Cardiovasc Thorac Surg. 2016;22(3):336–45. https://doi.org/10.1093/icvts/ivv368.

    Article  PubMed  Google Scholar 

  6. Shamszad P, Khan MS, Rossano JW, Fraser CD Jr. Early surgical therapy of infective endocarditis in children: a 15-year experience. J Thorac Cardiovasc Surg. 2013;146(3):506–11. https://doi.org/10.1016/j.jtcvs.2012.12.001.

    Article  PubMed  Google Scholar 

  7. Foster MA, Walls T. High rates of complications following Kingella kingae infective endocarditis in children: a case series and review of the literature. Pediatr Infect Dis J. 2014;33(7):785–6. https://doi.org/10.1097/INF.0000000000000303.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine/Pediatrics, University of Illinois College of Medicine at Peoria, 1 Illini Dr, Peoria, IL, USA

    Daniel R O’Brien

  2. Congenital Heart Center, Children’s Hospital of Illinois, 420 NE Glen Oak Ave, Peoria, IL, USA

    Cecilia A Albaro & Sujata Subramanian

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  1. Daniel R O’Brien
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  2. Cecilia A Albaro
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  3. Sujata Subramanian
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Each listed author substantially contributed to the design and drafting of this manuscript and approve its final version.

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Correspondence to Sujata Subramanian.

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O’Brien, D.R., Albaro, C.A. & Subramanian, S. Mitral Valve Endocarditis in a Pediatric Patient: When Is the Right Time to Intervene? A Case Report. SN Compr. Clin. Med. 2, 829–832 (2020). https://doi.org/10.1007/s42399-020-00308-x

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  • DOI: https://doi.org/10.1007/s42399-020-00308-x

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