ACTIVE INFECTIVE ENDOCARDITIS IN INFANTS AND CHILDHOOD - 10-YEAR REVIEW OF SURGICAL THERAPY

We review our 10-year (June 1987-June 1997) experience in 26 children requiring early surgery due to active infective endocarditis (AIE) ref ractory to medical therapy. Mean age at operation was 5.0 (SD 3.5) yea rs. Nineteen patients (73%) had predisposing factors: congenital heart disease (CHD) was the most common (10/19, 53%); endocavitary foreign materials (6/19); and previous cardiac surgery (3/19). Vegetations or valve dysfunction was detected by transthoracic echocardiography in ai l cases but one. Valvular location (17/26, 65%) was the most common; o thers locations included cardiac chambers (8/26) and intravascular tho racic aorta (1/26). Bacterial isolation was achieved in 19 patients (7 3%): Staphylococcus (10 patients); Streptococcus (6 patients); and Can dida albicans (3 patients). The indication for surgery was progressive or persistent cardiac failure (2 patients) or infection (9 patients), or a combination of these (7 patients), despite adequate medical ther apy; major embolic accident with a mobile vegetation (4 patients), rec urrent pulmonary embolism with a mobile vegetation (3 patients), and m obile vegetation (> 10 mm) in left cardiac chambers (1 patient). Ail t he patients required surgery before 6 weeks of antibiotic therapy had been completed. The hospital mortality was 19% (5/26, 70% confidential limits[CL]: 2-35%). Deaths were due to infective causes in all Gases but one. No late deaths occured in 18 patients followed up for a mean of 4.2 years (SD 2.4). Three patients needed four reoperations. We con clude that improvement In the treatment of children with AIE can be ob tained with an early and accurate diagnosis, an adequate antibiotic tr eatment, and a more aggresive surgical approach.