Changing patterns and prognosis of infective endocarditis in childhood

Area of Science:

• Pediatric Cardiology
• Infectious Diseases
• Cardiovascular Surgery

Background:

• Infective endocarditis (IE) incidence in children hospitalized in pediatric cardiology units is approximately 0.5%.
• IE is increasingly affecting younger children, with a rise in those under one year of age.
• Congenital heart disease is the predominant predisposing factor for IE in children, with a notable increase in cases involving prior surgical operations.

Purpose of the Study:

• To analyze trends in infective endocarditis in children over two decades.
• To identify changes in predisposing factors, causative agents, diagnostic methods, complications, and outcomes.

Main Methods:

• Retrospective study of 69 pediatric IE cases from 1971-1992.
• Data collection on patient demographics, cardiac history, microbiology, diagnostic imaging, interventions, and outcomes.
• Comparison of two time periods: 1971-1981 (Group I) and 1982-1992 (Group II).

Main Results:

• A moderate increase in IE incidence was observed, with a higher proportion in infants.
• Congenital heart disease was the primary underlying condition (72%), with increasing rates of prior surgery and complex defects.
• Echocardiography played a crucial diagnostic role, detecting vegetations in 64% of cases in Group II.
• Complications, including emboli and heart failure, remained high (75%), but mortality decreased significantly from 12% to 3% due to increased cardiovascular surgery.

Conclusions:

• Despite improved outcomes and reduced mortality, infective endocarditis in children presents ongoing challenges.
• Congenital heart disease necessitates vigilant monitoring for IE, especially in post-operative patients.
• While cardiovascular surgery has improved survival, long-term cardiac condition deterioration remains a concern for a significant proportion of survivors.