Turk Kardiyol Dern Ars. 2005; 33(3): 141-148

Evaluation of pediatric patients with infective endocarditis: an 11-year experience

Şamil Hızlı¹, Arman Bilgiç^2
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OBJECTIVES
We retrospectively reviewed patients with infective endocarditis (IE).
STUDY DESIGN
Thirty-three patients (13 girls, 20 boys; mean age 8.6±4.3 years; range 9 months to 17 years) were treated for IE at Hacettepe University İhsan Doğramacı Children’s Hospital during an 11-year period. This retrospective evaluation included predisposing factors, signs and symptoms on presentation, physical examination and laboratory findings, treatment modalities, and the results.
RESULTS
Twenty-two (66.7%) and 11 (33.3%) patients had congenital and rheumatic heart diseases, respectively. Eleven patients (50%) with congenital heart disease had a history of previous surgery, six (54.6%) of whom were operated on two months before the diagnosis of IE. Antibiotics were used in 15 patients (45.5%) for various periods before a week to the diagnosis. Transthoracic echocardiography showed vegetations in 29 patients (87.9%). Blood cultures were positive in 54.6% of the patients, with gram-negative bacteria accounting for the majority of cases. Nineteen patients (57.6%) received medical therapy, while 14 patients (42.4%) were treated both medically and surgically. Echocardiographic findings were consistent with intraoperative findings. There were no deaths among surgically treated patients, whereas five patients (26.3%) died while on medical treatment, all of whom had cerebral, pulmonary, and/or renal emboli. The most frequent complications were congestive heart failure (36%), glomerulonephritis (27%), and peripheral embolism (21.2%).
CONCLUSION
Timely diagnosis and surgical treatment are of utmost importance in IE patients, particularly in those in whom gram-negative and staphylococcal bacteria may considerably increase morbidity and mortality.

Keywords: Child; echocardiography, transesophageal; embolism/ etiology; endocarditis, bacterial/etiology/diagnosis/drug therapy/ surgery; heart defects, congenital/complications; heart valve diseases; risk factors

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