OPERATIVE INTERVENTION IN ACTIVE ENDOCARDITIS IN CHILDREN - REPORT OFA SERIES OF CASES AND REVIEW

We describe in detail 14 children (age, less-than-or-equal-to 19 years ) who underwent operative intervention during active infection of the heart and/or great vessels. The series included five children < 6 year s old, who constitute 10% of all such cases reported in this age group to date. We also review the 132 published reports in which children u nderwent operative intervention during active endocarditis. We found t he following: (1) The survival rate for all cases was 77%. (2) Persist ent infection, embolic phenomena, and increasing congestive heart fail ure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antib iotic treatment. (4) Survival rates were independent of positive resul ts of cultures of blood or tissue obtained at operation. (5) The perio perative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for remo val of catheter-associated cardiac masses from neonates, operative int ervention in active endocarditis was uncommon among children < 4 years old. (8) Staphylococcus aureus and viridans streptococci were the eti ologic agents in the majority of cases of endocarditis requiring opera tion during active infection in children.