Pediatric bacterial endocarditis

ABSTRACT

The authors studied 18 cases of endocarditis. Thirteen of the patients (72%) had underlying congenital heart disease and 5 (28%) had rheumatic heart disease. Fifteen patients had positive blood cultures, most commonly caused by Streptococcus viridans, Staphylococcus aureus, and Streptococcus mitis. At diagnosis, 11 patients (group A) were in functional class I and 7 (group B) were in functional class II, based on the criteria of the New York Heart Association. Medical therapy alone was instituted in 11 (60%). Seventeen patients were followed up for one month to 27 years. All 11 patients in group A were still in class I. Three of the 7 patients in group B were still in class II, although 1 had been rehospitalized for recurrent endocarditis. Due to the uncorrected congenital lesion, 1 group B patient was categorized in functional class III at follow-up. Three patients in group B died of complications from endocarditis (2 within the year of initial diagnosis), and 1 was lost to follow-up. With medical and surgical treatment, most pediatric patients with endocarditis remain hemodynamically stable at long-term follow-up. The functional class prior to treatment appears to be predictive of long-term functional status.