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

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 less than 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 second most frequent (17%). Six patients died, all were under two years of age and all had congestive heart failure. Early surgical correction of the congenital heart disease may offer the best form of prevention.