All issues > Volume 43(4); 2000

Original Article

J Korean Pediatr Soc. 2000;43(4):526-534. Published online April 15, 2000.

Infective Endocarditis in Children : Review of 35 Cases over 11 Years(1987-1997)

Jeong Jin JJ Yu¹, Young Ho YH Kwak¹, Jung-Youn JY Hong¹, He Sun HS Jung¹, Jin Young JY Song¹, Hoan Jong HJ Lee¹, Chung Il CI Noh¹, Jung Yun JY Choi¹, Yong Soo YS Yun¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea

Abstract

Purpose
: Infective endocarditis(IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis.
Methods
: The clinical records of children diagnosed as IE at the Seoul National University Children`s Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG.
Results
: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG(early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease(CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases(33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram(－) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG(23.5% versus 0%, P=0.033).
Conclusion
: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.

Keywords :Endocarditis, Duke criteria