Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex 77030, USA.
J Thorac Cardiovasc Surg. 2013 Sep;146(3):506-11. doi: 10.1016/j.jtcvs.2012.12.001. Epub 2013 Jan 9.
Infective endocarditis is rare in children but potentially carries high mortality and morbidity. Few data exist regarding surgical therapy and the associated outcomes in children with infective endocarditis. The aim of the present study was to describe the characteristics and outcomes of children undergoing surgery for infective endocarditis.
A retrospective review of all patients aged 21 years or younger diagnosed with definitive infective endocarditis at a single center from 1996 to 2010 was performed.
Of 76 identified patients with infective endocarditis (median age, 8.3 years; 73.9% boys), 46 patients (61%) required surgical intervention. Staphylococcus aureus was most commonly isolated (18 patients, 24%) followed by Streptococcus (17 patients, 22%). Common surgical indications included severe valvular insufficiency in 13 patients, septic embolization in 12, concomitant severe valvular insufficiency and ventricular dysfunction in 9, persistent vegetations in 9, and persistent bacteremia in 3. Although early surgery was performed within 7 days of diagnosis in 35 patients (76%), 25 (54%) underwent surgery within 3 days or less. The factors associated with surgery included the presence of ventricular dysfunction, left-sided vegetation, severe valvular insufficiency, septic embolization, and S aureus. Surgery within 3 days or less was associated with the presence of ventricular dysfunction and S aureus. Native valve repair was performed in 50% of patients with native-valve disease. Postoperatively, no septic embolization events occurred and recurrence was low (2%). The 1-, 5-, and 10-year survival was 98% ± 2%, 90% ± 8%, and 81% ± 11%, respectively.
Children with infective endocarditis can undergo successful early surgical therapy with a low risk of septic embolization, recurrence, and operative mortality.
儿童感染性心内膜炎较为罕见，但可能导致高死亡率和高发病率。目前关于儿童感染性心内膜炎的手术治疗及相关结局的数据较少。本研究旨在描述因感染性心内膜炎接受手术治疗的儿童的特征和结局。
对 1996 年至 2010 年期间在一家单中心确诊为明确感染性心内膜炎的 21 岁及以下所有患者进行了回顾性分析。
在 76 例确诊为感染性心内膜炎的患者中（中位年龄为 8.3 岁，73.9%为男性），46 例（61%）需要手术干预。最常见的病原体是金黄色葡萄球菌（18 例，24%），其次是链球菌（17 例，22%）。常见的手术适应证包括 13 例严重瓣膜功能不全、12 例感染性栓塞、9 例合并严重瓣膜功能不全和心室功能障碍、9 例持续性赘生物和 3 例持续性菌血症。尽管 35 例（76%）患者在确诊后 7 天内进行了早期手术，但仍有 25 例（54%）在 3 天或更短时间内进行了手术。与手术相关的因素包括存在心室功能障碍、左侧赘生物、严重瓣膜功能不全、感染性栓塞和金黄色葡萄球菌。3 天或更短时间内进行手术与存在心室功能障碍和金黄色葡萄球菌有关。50%的原发性瓣膜疾病患者进行了瓣膜修复。术后无感染性栓塞事件发生，复发率低（2%）。1 年、5 年和 10 年生存率分别为 98%±2%、90%±8%和 81%±11%。
儿童感染性心内膜炎患者可成功接受早期手术治疗，感染性栓塞、复发和手术死亡率的风险较低。
