Infective endocarditis of the Dacron patch-a report of 13 cases at autopsy

Abstract

Aims: One of the complications of using a synthetic material as a patch in correction of left-to-right shunts is the development of infection. This is an autopsy report of 13 patients who developed infective endocarditis of the Dacron patch as a postoperative complication.

Methods: We retrospectively reviewed the autopsy records of patients with infective endocarditis over a 15-year period (1994-2008) and selected cases with Dacron-patch infective endocarditis. The patch infective endocarditis was classified into early-onset and late-onset infective endocarditis.

Results: Patch infective endocarditis was seen in 13 patients affecting the patches covering an atrial septal defect and 12 ventricular septal defects. There were nine males and four females, with a mean age of 13.1 years. The episodes occurred 2 to 118 days (mean of 30) after operation, with early-onset infective endocarditis in 10 and late-onset infective endocarditis in three patients. Postoperative wound infection had been present in eight. The organisms isolated or demonstrated on microscopy included Staphylococcus aureus (5), gram-positive cocci (4), Pseudomonas (2), Aspergillus species (1), and Candida species (1). Death was related to embolization and/or accompanying septicemia.

Conclusions: Correction of simple or complex congenital cardiac defects offers new substrates for organisms to colonize resulting in infective endocarditis, which are often difficult to treat.