Department of Pediatric Cardiology and Cardiothoracic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
Department of Pediatric Infectious Diseases, Stony Brook Children's Hospital, Stony Brook, NY, USA.
Pediatr Cardiol. 2022 Dec;43(8):1929-1933. doi: 10.1007/s00246-022-02938-5. Epub 2022 Jun 3.
Congenital heart disease (CHD) is the most common predisposing factor for pediatric infective endocarditis (IE). Although patients with unrepaired ventricular septal defects (VSDs) are at greater risk of IE than those without CHD, the American Heart Association (AHA) considers VSDs to be relatively low risk and therefore does not recommend antibiotic prophylaxis against IE. Even among patients with VSDs who develop IE, current AHA and European Society for Cardiology (ESC) guidelines do not recommend surgical VSD closure, despite the potential for a second IE event. We present a case series of four children with small, restrictive, perimembranous VSDs who developed tricuspid valve (TV) IE. All four experienced delayed diagnosis and secondary complications, including three with septic pulmonary emboli. All four patients ultimately underwent surgical VSD closure. These cases highlight the importance of recognizing IE as a possible cause of prolonged fever in children, even among those with even 'low-risk' CHD. The cases also draw attention to the potential benefits of VSD closure in patients who develop IE.
先天性心脏病（CHD）是小儿感染性心内膜炎（IE）最常见的易患因素。尽管未修复的室间隔缺损（VSD）患者比无 CHD 的患者更容易发生 IE，但美国心脏协会（AHA）认为 VSD 的风险相对较低，因此不建议预防性使用抗生素来预防 IE。即使在发生 IE 的 VSD 患者中，目前的 AHA 和欧洲心脏病学会（ESC）指南也不建议进行 VSD 手术闭合，尽管存在再次发生 IE 的风险。我们报告了 4 例小儿小、限制型、膜周部 VSD 并发三尖瓣 IE 的病例系列。这 4 例患儿均延迟诊断并出现继发性并发症，包括 3 例出现脓毒性肺栓塞。这 4 例患者最终均接受了 VSD 手术闭合。这些病例强调了即使在“低危”CHD 患者中，也应将 IE 作为儿童持续性发热的可能原因加以识别。这些病例还提请注意，对于发生 IE 的患者，VSD 闭合可能带来益处。
