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Operative intervention in active endocarditis in children: report of a series of cases and review
R W Tolan1, M B Kleiman, M Frank
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
Insights
Operative intervention for active infective endocarditis in children shows a 77% survival rate. Key indications include persistent infection and heart failure, with outcomes independent of antibiotic duration or culture results.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Active infective endocarditis in children often necessitates surgical intervention.
- This study details operative cases in pediatric patients with active heart infections.
Observation:
- 14 children (≤19 years) underwent operative intervention during active cardiac infection.
- Five patients were under 6 years old, representing 10% of reported cases in this age group.
- A review of 132 published reports on pediatric endocarditis surgery was conducted.
Findings:
- Overall survival rate was 77%, with a 14% perioperative mortality.
- Indications for surgery included persistent infection, embolic phenomena, and congestive heart failure.
- Survival rates were not influenced by preoperative antibiotic duration or positive operative cultures.
- Staphylococcus aureus and viridans streptococci were common causative agents.
Implications:
- Operative intervention is a critical treatment for pediatric infective endocarditis.
- Early surgical management may improve outcomes in complex pediatric cardiac infections.
- Further research into risk factors and optimal timing for intervention in young children is warranted.
Abstract:
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 less than 6 years 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 underwent operative intervention during active endocarditis. We found the following: (1) The survival rate for all cases was 77%. (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antibiotic treatment. (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation. (5) The perioperative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old. (8) Staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.