SPECTRUM OF INFECTIVE ENDOCARDITIS DURING INFANCY AND CHILDHOOD - 20-YEAR REVIEW

The medical records of the 29 patients under 18 years of age with infe ctive endocarditis (IE) seen over a 20-year period by our department w ere reviewed to provide an overview of the spectrum of IE during infan cy and childhood. None of the 29 patients had had previous cardiovascu lar surgery. The mean age at onset of IE was 7 years 2 months; 3 patie nts (10%) were under 2 years of age at onset. One patient during the e arly years died following 4 months of treatment with various antibioti cs. Three patients underwent urgent surgery, and 17 patients with heal ed IE had elective surgery. All of the 20 patients who were operated o n survived. The remaining 8 were followed with medical treatment alone . Positive blood cultures were obtained from 24 (83%) patients, and st reptococci were still commonly found (38%). Ventricular septal defect (VSD) accounted for 66% of underlying heart diseases and rheumatic hea rt diseases for 14%. Vegetations were detected in 12 (67%) of 18 patie nts observed by echocardiography. Among these 12 patients, 1 with VSD underwent urgent tricuspid valve replacement and VSD closure because o f worsening congestive heart failure due to progressive tricuspid regu rgitation. Echocardiography identifies patients at high risk with IE, though the presence of a vegetation on echocardiography does not neces sarily of itself dictate surgical intervention.