Saxena Anita, Aggarwal Neeraj, Gupta Pankaj, Juneja Rajnish, Kothari Shyam S, Math Ravi
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Indian Heart J. 2011 May-Jun;63(3):237-40.
Infective endocarditis is an uncommon disease in children, but is often associated with significant morbidity and mortality. Embolization of vegetation to systemic or pulmonary circulation is a major contributor to morbidity and mortality of infective endocarditis, its incidence in adults varies from 22% to 40%. Very little data exists on the incidence and predictors of embolisation in children. We analysed the clinical and echocardiographic data of 50 consecutive children admitted to our centre with infective endocarditis over a five year period to determine the predictors of embolization.
This was a retrospective study of children below 12 years of age, who were admitted in the ward with a diagnosis of infective endocarditis. Their demographic, clinical, hematological and echocardiographic data were analysed to look for predictors of embolic events. The details of treatment and course in the hospital were also recorded.
The mean age was 6 +/- 3.6 years with a range from 4 months to 12 years. Congenital heart disease was the underlying diagnosis in 44 cases. Twenty three cases had undergone cardiac surgery earlier. Blood cultures were positive in only 19 cases (38%). Seven children grew fungus in their blood culture. Echocardiography revealed vegetation in all; the size of vegetation was > 10 mm in 18 cases and < 3 mm in 11. Clinically obvious embolisation occurred in 23 cases (46%), the size of vegetation was > 10 mm in 13. Embolic events were more common when vegetation was present in the right sided valves or chambers (16/24, 66%). Embolic events were acutely fatal in 7 cases, 6 of these had vegetations which were > 10 mm. Repeat echocardiography failed to show regression of vegetation size in 19/23 cases with embolic events, as against 15/27 without embolic events. A total of 11 patients died. Thirteen patients underwent surgery, 9 within two weeks of treatment.
In our study, large vegetations (> 10 mm) at presentation and failure to diminish in size on treatment are predictors of embolisation. Vegetations on right side of the heart are more likely to embolise.
感染性心内膜炎在儿童中是一种罕见疾病，但常伴有显著的发病率和死亡率。赘生物栓塞至体循环或肺循环是感染性心内膜炎发病率和死亡率的主要原因，其在成人中的发生率为22%至40%。关于儿童栓塞发生率及预测因素的数据非常少。我们分析了连续5年入住本中心的50例感染性心内膜炎患儿的临床和超声心动图数据，以确定栓塞的预测因素。
这是一项对12岁以下因感染性心内膜炎入住病房患儿的回顾性研究。分析他们的人口统计学、临床、血液学和超声心动图数据，以寻找栓塞事件的预测因素。还记录了治疗细节和住院病程。
平均年龄为6±3.6岁，范围从4个月至12岁。44例潜在诊断为先天性心脏病。23例患儿曾接受过心脏手术。血培养仅19例（38%）呈阳性。7例患儿血培养出真菌。超声心动图显示所有患儿均有赘生物；赘生物大小>10mm的有18例，<3mm的有11例。23例（46%）发生临床明显栓塞，其中13例赘生物大小>10mm。当右侧瓣膜或心腔存在赘生物时，栓塞事件更常见（16/24，66%）。7例栓塞事件为急性致命性，其中6例赘生物>10mm。23例有栓塞事件的患儿中，19例重复超声心动图显示赘生物大小未缩小，而27例无栓塞事件的患儿中，15例显示赘生物大小未缩小。共有11例患儿死亡。13例患儿接受了手术，9例在治疗后两周内进行。
在我们的研究中，就诊时存在大的赘生物（>10mm）以及治疗后赘生物大小未缩小是栓塞的预测因素。心脏右侧赘生物更易发生栓塞。
