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. 1987 Jul;58(1):57–65. doi: 10.1136/hrt.58.1.57

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

T Karl, D Wensley, J Stark, M de Leval, P Rees, J F Taylor
PMCID: PMC1277248  PMID: 3620243

Abstract

The diagnostic and prognostic features of 44 episodes of infective endocarditis in 42 children with congenital heart disease were reviewed. Endocarditis occurred in 18 patients who had not had surgical correction or palliation of the defect (non-operated group). There were 26 episodes in 24 patients who had been treated surgically (operated group) (16 open and eight closed cardiac operations). Endocarditis occurred soon after open heart surgery in eight patients and as a late complication in the other 16. It recurred in two patients (operated group). Invasive monitoring and low cardiac output were consistent features in those patients who had endocarditis soon after open heart surgery whereas dental treatment was a common feature in non-operated cases and after closed cardiac operations. Late cases of endocarditis after open heart surgery had various microbiological features that were not typical of infection after dental problems. Gram positive infections occurred in non-operated patients and in those who had had closed cardiac operations. The group that had open heart surgery had infections caused by Gram positive, Gram negative, and anaerobic bacteria and fungi. Fever, anaemia, leucocytosis, and positive blood cultures were the only consistent findings. Vegetations were seen in nine of 12 patients at cross sectional echocardiography. All 12 (four non-operated, one closed, and seven open cases) needed acute surgical treatment. The mortality from infective endocarditis was 17% for non-operated cases, 0% for those who had had closed heart surgery, and 50% for those who had had open heart surgery. Infective endocarditis after open heart surgery differs from that in the other subgroups in terms of microbiology, source of infection, and outcome and its early diagnosis depends on a thorough investigation of minimal symptoms and signs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. COHEN L., FREEDMAN L. R. Damage to the aortic valve as a cause of death in bacterial endocarditis. Ann Intern Med. 1961 Oct;55:562–564. doi: 10.7326/0003-4819-55-4-562. [DOI] [PubMed] [Google Scholar]
  2. Cannady P. B., Jr, Sanford J. P. Negative blood cultures in infective endocarditis: a review. South Med J. 1976 Nov;69(11):1420–1424. doi: 10.1097/00007611-197611000-00008. [DOI] [PubMed] [Google Scholar]
  3. Corone P., Doyon F., Gaudeau S., Guérin F., Vernant P., Ducam H., Rumeau-Rouquette C., Gaudeul P. Natural history of ventricular septal defect. A study involving 790 cases. Circulation. 1977 Jun;55(6):908–915. doi: 10.1161/01.cir.55.6.908. [DOI] [PubMed] [Google Scholar]
  4. Deverall P. B., Taylor J. F., Aberdeen E., Waterston D. J. Left ventricular-right atrial communication. Ann Thorac Surg. 1969 Dec;8(6):498–505. doi: 10.1016/s0003-4975(10)66086-9. [DOI] [PubMed] [Google Scholar]
  5. Jamieson M. P., Rees P. G., Stark J., de Leval M. Tricuspid endocarditis with ventricular septal defect. Case report with surgical management. Thorac Cardiovasc Surg. 1980 Feb;28(1):48–50. doi: 10.1055/s-2007-1022050. [DOI] [PubMed] [Google Scholar]
  6. Johnson D. H., Rosenthal A., Nadas A. S. A forty-year review of bacterial endocarditis in infancy and childhood. Circulation. 1975 Apr;51(4):581–588. doi: 10.1161/01.cir.51.4.581. [DOI] [PubMed] [Google Scholar]
  7. Kay J. H., Berstein S., Tsuji H. K., Redington J. V., Milgram M., Brem T. Surgical treatment of candida endocarditis. JAMA. 1968 Feb 26;203(9):621–626. [PubMed] [Google Scholar]
  8. Pelletier L. L., Jr, Petersdorf R. G. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine (Baltimore) 1977 Jul;56(4):287–313. [PubMed] [Google Scholar]
  9. Pesanti E. L., Smith I. M. Infective endocarditis with negative blood cultures. An analysis of 52 cases. Am J Med. 1979 Jan;66(1):43–50. doi: 10.1016/0002-9343(79)90480-7. [DOI] [PubMed] [Google Scholar]
  10. Richardson J. V., Karp R. B., Kirklin J. W., Dismukes W. E. Treatment of infective endocarditis: a 10-year comparative analysis. Circulation. 1978 Oct;58(4):589–597. doi: 10.1161/01.cir.58.4.589. [DOI] [PubMed] [Google Scholar]
  11. Rubenson D. S., Tucker C. R., Stinson E. B., London E. J., Oyer P., Moreno-Cabral R., Popp R. L. The use of echocardiography in diagnosing culture-negative endocarditis. Circulation. 1981 Sep;64(3):641–646. doi: 10.1161/01.cir.64.3.641. [DOI] [PubMed] [Google Scholar]
  12. Shah P., Singh W. S., Rose V., Keith J. D. Incidence of bacterial endocarditis in ventricular septal defects. Circulation. 1966 Jul;34(1):127–131. doi: 10.1161/01.cir.34.1.127. [DOI] [PubMed] [Google Scholar]
  13. Sipes J. N., Thompson R. L., Hook E. W. Prophylaxis of infective endocarditis: a reevaluation. Annu Rev Med. 1977;28:371–391. doi: 10.1146/annurev.me.28.020177.002103. [DOI] [PubMed] [Google Scholar]
  14. Starkebaum M., Durack D., Beeson P. The "incubation period" of subacute bacterial endocarditis. Yale J Biol Med. 1977 Jan-Feb;50(1):49–58. [PMC free article] [PubMed] [Google Scholar]
  15. Teich E. M. Afebrile bacterial endocarditis. A clinical study of two cases. J Mt Sinai Hosp N Y. 1968 Nov-Dec;35(6):566–577. [PubMed] [Google Scholar]
  16. Watanakunakorn C. Prosthetic valve infective endocarditis. Prog Cardiovasc Dis. 1979 Nov-Dec;22(3):181–192. doi: 10.1016/0033-0620(79)90022-7. [DOI] [PubMed] [Google Scholar]

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