[Surgical treatment of infective endocarditis in patients with congenital heart disease].

From 1981 to March 1993, 21 patients underwent surgical treatment for infective endocarditis (IE) associated with congenital heart disease (CHD). We evaluated the surgical results with regard to various factors, including microorganisms, pre- and postoperative complications, the correlation between CHD and the infective focus in the valve, the operative methods and surgical results. Underlying CHD included ventricular septal defect (VSD) in 15 (71.5%), persistent ductus arteriosus (PDA) in 2 (9.5%), tetralogy of Fallot (TF) in 2 (9.5%) and incomplete endocardial cushion defect (IECD) in 2 patients (9.5%). Microorganisms were detected in 71.4% of the patients, including streptococcus in 11 patients (52.4%), staphylococcus in 2 (9.5%) and gram-negative bacillin in 2 (9.5%). Embolism or infarction was noted preoperatively in 5 patients (23.8%) and was located in the kidney in 4 patients, the leg in 2, and in the liver and lung in 1 patient each. Among 15 patients with VSD, the lesion of IE was seen on the left side of the heart in 11 patients, on the right side in 3 and on both sides in 1. The PDA and IECD were seen on the left side in 2 patients each, but the IE focus of the 2 patients with TF was on the left side in one and on both sides in the other patient. Aortic valve replacement was performed in 17 patients, mitral valve replacement in 3, tricuspid valve plasty in 2, tricuspid annuloplasty in 1 and pulmonary valve resection in 2 patients. The operative mortality was 4.8% and there were no reoperations or late deaths.(ABSTRACT TRUNCATED AT 250 WORDS)