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Surgical management of infective endocarditis in children
1Department of Surgery, University of Louisville, Kentucky.
Insights
Aggressive surgical intervention for pediatric infective endocarditis, particularly in congenital heart disease patients, is crucial. Procedures range from vegetation resection to valve repair, with pericardium proving useful for reconstruction.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Infective endocarditis is rare in children, often associated with congenital heart disease.
- Surgical management requires a balance of aggressive intervention and conservative reconstruction.
Purpose of the Study:
- To review surgical strategies for pediatric infective endocarditis.
- To evaluate outcomes of aggressive intervention with reconstructive techniques.
Main Methods:
- Retrospective review of 16 pediatric patients (3 weeks–16 years) undergoing 19 intracardiac operations for infective endocarditis (1982–1989).
- Procedures included vegetation resection, valve replacement, valvuloplasty, and abscess cavity exclusion using pericardium or prosthetic valves.
Main Results:
- Operative mortality was 25%, linked to preoperative disease severity.
- Common pathogens included Staphylococcus, Haemophilus influenzae, and gram-negative organisms.
- Pericardium was effectively used for reconstruction in complex cases.
Conclusions:
- Aggressive surgical exploration is indicated for pediatric infective endocarditis.
- Preserving valvular tissue and utilizing pericardium for reconstruction are key strategies.
Abstract:
Infective endocarditis occurs infrequently in the general pediatric population, occurring mostly in patients with congenital heart disease. This study reviews our surgical experience with infective endocarditis based on a policy of aggressive intervention, conservative operative debridement, and creative reconstruction options using pericardium and prosthetic heart valves. From 1982 to 1989, 16 patients, 3 weeks to 16 years of age, underwent 19 intracardiac operations for infective endocarditis therapy at Kosair Children's Hospital. Eight (42%) were for resection of vegetations alone; an additional 11 operations (58%) involved more extensive debridements requiring either valve replacement or valvuloplasty using pericardium for exclusion of an abscess cavity, closure of a fistula, or for valve repair. Operative mortality was 25% (4 patients) and related to preoperative disease severity. There was one late death. Offending organisms included Staphylococcus species (31%), Haemophilus influenzae (13%), pneumococcus (5%), gram-negative organisms (13%), and Candida (13%); no organism grew on culture in 25%. We conclude that aggressive surgical exploration in patients with infective endocarditis is indicated and often requires resection of vegetations alone. More extensive procedures should preserve as much valvular tissue as possible. Pericardium is useful for reconstruction after debridement.