[Clinical and therapeutic considerations in children with infective endocarditis]

Abstract

Purpose: the aim of this study was to analyse the clinical course, complications and treatment in children with infective endocarditis (IE).

Material and methods: study group concerned 39 children with IE, aged 2.5 months - 15 years. The diagnosis was based on clinical symptoms, laboratory results and echocardiographic evaluation.

Results: among 39 children, in 36 cardiac anomalies (in 35 congenital and in 1 acquired heart lesions) were recognized prior to development of IE. In 3 children with normal heart, endocarditis was part of septicaemia. Positive blood cultures were present in 69.2% of patients, mostly Streptococci and Staphylococci. In one patient Aspergillus fumigatus was the etiologic factor of endocarditis. In 17 children cardiac failure was diagnosed and in 7 acute severe regurgitation of aortic valve in 3, mitral valve in 2, both aortic and mitral insufficiency in 2. One child with perforation of the tricuspid valve leaflet presented signs of renal failure. In 15 children the following complications were diagnosed: cerebral and/or systemic emboli, mycotic aneurysm of the sinus of Valsalva, abscess of aortic annulus, rupture of valve leaflets with severe insufficiency and recurrence of hemodynamically significant VSD. All children were given intravenous antibiotics. 13 patients were operated, 6 had cardiosurgery as an emergency. Four children died including 1 after cardiosurgery.

Conclusions: 1. Acute heart failure in children with infective endocarditis is most often caused by severe aortic and / or mitral valve regurgitation. 2. Urgent cardiosurgery is the treatment of choice in children with acute heart failure or big and mobile vegetations. 3. Echocardiography plays a major role in the diagnosis of infective endocarditis and its complications.