Surgery of Pediatric Infective Endocarditis: An Update

Summary

Recent advances in cardiac surgery have increased the likehood of survival in pediatric patients with infective endocarditis (IE). However, controversy still exists with regard to the indications as well as the timing of surgery in patients with active disease. This retrospective study summarizes our surgical experience with IE in children during the past 12 years, with an attempt to set up current guidelines for operative therapy. From January 1981 to December 1993, 21 children with IE were treated surgically. All except one infant had underlying cardiac lesions. Eighteen patients (86%) had associated congenital heart defects, and 2 patients had rheumatic heart disease with mitral regurgitation. Staphylococcus aureus and Streptococcus viridans were the most common infecting organisms. Urgent operations were performed on 9 patients, and 12 patients underwent elective surgery. There were three deaths in this series: two deaths were of patients who underwent concomitant repair of complex congenital heart disease and one death was that of a 3-month-old infant with a normal heart. The overall mortality rate was 14.3%. Although all the mortality occurred among the patients who received urgent operation for IE, satisfactory valve repair instead of valve replacement was only feasible for those patients whose operative procedures were performed on an urgent basis. In conclusion, surgery of IE in children still carries high risks, especially in patients with complex congenital heart disease. However, to prevent serious complications of IE, early surgical intervention before the onset of hemodynamic deterioration should be encouraged.