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Ann Thorac Surg 1992;54:755-760
© 1992 The Society of Thoracic Surgeons

Articles

Surgical management of infective endocarditis in children

Michael Citak, MD, Allan Rees, MD, Constantine Mavroudis, MD*

Departments of Surgery and Pediatrics, University of Louisville, Louisville, Kentucky, USA

Accepted for publication February 24, 1992.

* Address reprint requests to Dr Mavroudis, Division of Cardiovascular-Thoracic Surgery, The Children's Memorial Hospital, M/C #22, 2300 Children's Plaza, Chicago, IL 60614.

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




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