Surgical management of infective endocarditis in children

doi:10.1016/0003-4975(92)91023-3

The Annals of Thoracic Surgery

Volume 54, Issue 4, October 1992, Pages 755-760

https://doi.org/10.1016/0003-4975(92)91023-3 Get rights and content

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

References (21)

T Zakrzewski et al.
Bacterial endocarditis in infants and children
J Pediatr
(1965)
C Mavroudis et al.
Modified aortoseptoplasty for anular abscess and erosion of the membranous septum
Chest
(1984)
IK Crosby et al.
Operative management of valvular complications of bacterial endocarditis
J Thorac Cardiovasc Surg
(1972)
EB Stinson et al.
Operative treatment of active endocarditis
J Thorac Cardiovasc Surg
(1976)
ES Yee et al.
Reparative approach for right-sided endocarditis. Operative considerations and results of valvuloplasty
J Thorac Cardiovasc Surg
(1988)
CM Johnson et al.
Pediatric endocarditis
K King et al.
Infective endocarditis in the 1980s. Part 1. Aetiology and diagnosis
Med J Aust
(1986)
T Karl et al.
infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without
Br Heart J
(1987)
J Schollin et al.
Infective endocarditis in Swedish children. I. Incidence, etiology, underlying factors and port of entry of infection
Acta Paediatr Scand
(1986)
J Schollin et al.
Infective endocarditis in Swedish children. II. Location, major complications, laboratory findings, delay of treatment, treatment and outcome
Acta Paediatr Scand
(1986)

There are more references available in the full text version of this article.

Cited by (67)

Surgical Treatment of Giant Candida albicans Vegetation of Tricuspid Valve Endocarditis in a Preterm Baby
2015, Pediatrics and Neonatology
Citation Excerpt :
It is a well-known fact that penetration of antifungal agents (notably, amphotericin B) into the infection site is poor, and surgery is almost always needed in most of the elderly patients. By contrast, in neonates a consensus for the appropriate management of fungal endocarditis is lacking.7,8 A combination of medical and surgical approach has been advocated to treat infants who have ultimately survived Candida endocarditis.
Successful management of fungal pericarditis and endocarditis in a neonate: A case report
2012, Journal of the Saudi Heart Association
Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60 days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.
Antibiotic sandwich patch for ventricular septal defect complicated by endocarditis
2011, Annals of Thoracic Surgery
Citation Excerpt :
A continued concern is the use of intracardiac prosthetic material that could be colonized during and after surgery. Autologous pericardium is preferred to prosthetic material whenever reconstruction is required [5]. The ASP was developed to protect patients after VSD closure, aiming at reducing the risk of recurrence of AIE.
Infective endocarditis in patients with ventricular septal defects can prove life threatening due to acute heart failure or septic embolization. Persistent postoperative risk is bacterial colonization of prosthetic material. We designed the Antibiotic Sandwich Patch to reduce this risk, using a double layer of autologous pericardium containing antibiotic powder. Five patients were managed with this technique for closure of ventricular septal defects complicated by acute infective endocarditis. No colonization of the patches occurred after a median follow up of 1.5 years. This technique reduced the risk of bacterial colonization of the antibiotic sandwich patch, offering an additional surgical option.
Mechanical left ventricular unloading to prevent recurrent myocardial rupture
2010, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
No cause was found for the staphylococcal septicemia. Although aortic root abscesses commonly occur in endocarditis, septic full-thickness erosion of ventricular myocardium is exceptionally rare and difficult to manage in a small heart from a female patient.2,3 The infected muscle disintegrated, and the coronary arteries were obscured by fibrin from the septic pericardial effusion.
INFECTIVE ENDOCARDITIS
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition
Cardiology: Cardiac infections - Endocarditis, myocarditis, and pericarditis
2007, Anales de Pediatria Continuada

View all citing articles on Scopus

View full text

Original articleSurgical management of infective endocarditis in children

Abstract

J Pediatr

Chest

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Pediatric endocarditis

Infective endocarditis in the 1980s. Part 1. Aetiology and diagnosis

Med J Aust

infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without

Br Heart J

Infective endocarditis in Swedish children. I. Incidence, etiology, underlying factors and port of entry of infection

Acta Paediatr Scand

Infective endocarditis in Swedish children. II. Location, major complications, laboratory findings, delay of treatment, treatment and outcome

Acta Paediatr Scand

Original article
Surgical management of infective endocarditis in children