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European Heart Journal 1988 9(11):1244-1249;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Carkology

Infective endocarditis in children with congenital heart disease: the changing spectrum, 1965—85

T. GEVA and M. FRAND

Department of Pediatrics C, the Chaim Sheba Medical Centre, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University Israel

Received 27 April 1988; .

Address for correspondence and reprint requests:Tal Geva, M D., Cardiac Registry, The Children's Hospital, 300 Longwood Ave. Boston MA 021I5.U.S.A.

Abstract

Thirty-five episodes of infective endocarditis in 35 children with congenital heart disease, from January 1965 to December 1984, were reviewed. The incidence of infective endocarditis in cyanotic congenital heart defects increased with a concomitant decrease in the frequency of lesions with left to right shunt. The incidence of postoperative endocarditis decreased from 1:52 during the first decade to 1:1033 during the second decade. The time interval between onset of symptoms and the establishment of diagnosis and treatment shortened from 7.8 ± 3.2 weeks (mean ± SD) to 2.1±0.9 weeks. During the latter decade, positive blood cultures were obtained in 100% of patients, as compared with 60% during the former decade (P ≤0.05). Echocardiography demonstrated vegetations in 70% of the cases. Over the entire time period, streptococcus viridans was the most frequent pathogen (46%) and staphylococcus aureus secondmostfrequent (17%). Six patients died, all were under two years of age and all had congestive heart failure. Early surgical correction of the congenital heartdisease may offer the best form of prevention.

Key Words: Infective endocarditis, • congenital heart disease, • cardiac surgery.


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