Infective Endocarditis in Pediatric Patients: An Eighteen-Year Experience from King Chulalongkorn Memorial Hospital
Pornthep Lertsapcharoen MD*, Apichai Khongphatthanayothin MD*, Pairoj Chotivittayatarakorn MD*, Chule Thisyakorn MD*, Chotima Pathmanand MD*, Viroj Sueblinvong MD*
Affiliation : * Department of Pediatrics, Chulalongkorn University and King Chulalongkorn Memorial Hospital
Objectives : To review the clinical features and outcome of the pediatric patients diagnosed with infective
endocarditis (IE) at King Chulalongkorn Memorial Hospital over an 18-year period.
Materials and Methods : From January 1987 to December 2004, 57 pediatric patients; 28 females and 29males,
age ranged from 2 months to 15 years, mean of 8.64 + 3.82 years, classified as “definite” IE according to the
Duke criteria were reviewed.
Results : Of the 57 patients, 42 patients (74%) had underlying congenital heart diseases, 7 patients (12%) had
underlying rheumatic heart disease, 8 patients (14%) had previously normal heart. Nine patients had history
of previously palliative or corrective surgery. Blood cultures were positive in 26 patients (46%). Streptococci
and staphylococci were the most commonly isolated organisms. Two-dimensional echocardiography demon-
strated vegetations in 56 patients (98%). The location of the vegetations was in the right heart in30 patients
(54%) and in the left heart in 26 patients (46%). Complications occurred in 28 patients (49%). Common
complications included congestive heart failure, cerebral emboli, septic shock, and mycotic aneurysm. The
overall mortality was 11% (6 patients). By statistical analysis, vegetations in the left heart had a higher
incidence of complication than that in the right heart. The vegetation size of > 10 mm had a significant higher
incidence of embolic events.
Conclusion : The clinical features and outcomes of the present study have a similar pattern as the earlier
studies. The rates of complications and mortality are still high.
Keywords : Infective endocarditis, Pediatric, Complication
