Willoughby Mark L, Basera Wisdom, Perkins Susan R, Comitis George A M, Fourie Barend, Lawrenson John B, Zühlke Liesl J
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Cardiol Young. 2019 Oct;29(10):1282-1286. doi: 10.1017/S1047951119002154. Epub 2019 Sep 2.
Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with "definite" and "possible" endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met "definite" and 36% "possible" criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9-47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
感染性心内膜炎是心脏内皮表面的微生物感染，主要累及心脏瓣膜，其死亡率和发病率都很高。在我们的环境中，关于受影响儿童的当代数据很少。
我们旨在描述我们机构中婴儿和儿童心内膜炎的概况和治疗结果。
这是对南非西开普省两家公立医院5年内患有心内膜炎的婴儿和儿童进行的回顾性分析。根据改良的杜克标准，患有“确诊”和“可能”心内膜炎的患者被纳入该综述。
确定49例患者纳入研究；29例有先天性心脏病作为易感因素；64%的患者符合“确诊”标准，36%符合“可能”标准。住院死亡率为20%；53%的患者接受了手术，术后死亡率为7.7%。从诊断到手术的中位间隔时间为20天（四分位间距为9 - 47天）。28%的患者进行了瓣膜置换，58%进行了瓣膜修复。接受手术的患者瓣膜功能障碍有显著改善，而接受药物治疗的患者仅有轻微改善。总体而言，43%的患者有一定程度的残余瓣膜功能障碍。
心内膜炎是一种严重疾病，住院死亡率高，准确诊断存在挑战。尽管瓣膜功能障碍有显著改善，但部分患者仍有残余瓣膜功能障碍。早期手术与较低的死亡率相关，但与延迟手术相比，瓣膜置换率更高。
