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Tricuspid Valve Endocarditis in Four Patients with Unrepaired Restrictive Perimembranous Ventricular Septal Defects

Adam M Butensky1, Alexandra Channing1, Andrew S Handel2

  • 1Department of Pediatric Cardiology and Cardiothoracic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.

Pediatric Cardiology
|June 3, 2022
PubMed

Insights

Pediatric infective endocarditis (IE) can occur in children with ventricular septal defects (VSDs). Surgical VSD closure may benefit children who develop IE, even with small defects.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases

Background:

  • Congenital heart disease (CHD) is a primary risk factor for infective endocarditis (IE) in children.
  • Current guidelines consider ventricular septal defects (VSDs) low-risk for IE and do not recommend antibiotic prophylaxis or surgical closure after IE develops.

Observation:

  • A case series of four pediatric patients with small, restrictive, perimembranous VSDs who developed tricuspid valve IE.
  • All patients experienced delayed diagnosis and complications, including septic pulmonary emboli in three.

Findings:

  • Despite guidelines, all four patients with VSDs and IE ultimately required surgical VSD closure.
  • IE should be considered in children with prolonged fever, even those with seemingly low-risk CHD.

Implications:

  • These cases suggest potential benefits of surgical VSD closure in pediatric IE patients.
  • Revisiting guidelines on antibiotic prophylaxis and surgical intervention for VSDs in the context of IE may be warranted.

Keywords:
EndocarditisIndications for surgerySeptic emboliTricuspid valveVentricular septal defect

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