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

Thirty-five episodes of infective endocarditis in 35 childrenwith congenital heart disease, from January 1965 to December1984, were reviewed. The incidence of infective endocarditisin cyanotic congenital heart defects increased with a concomitantdecrease in the frequency of lesions with left to right shunt.The incidence of postoperative endocarditis decreased from 1:52during the first decade to 1:1033 during the second decade.The time interval between onset of symptoms and the establishmentof diagnosis and treatment shortened from 7.8 ± 3.2 weeks(mean ± SD) to 2.1±0.9 weeks. During the latterdecade, positive blood cultures were obtained in 100% of patients,as compared with 60% during the former decade (P 0.05). Echocardiographydemonstrated vegetations in 70% of the cases. Over the entiretime period, streptococcus viridans was the most frequent pathogen(46%) and staphylococcus aureus secondmostfrequent (17%). Sixpatients died, all were under two years of age and all had congestiveheart failure. Early surgical correction of the congenital heartdiseasemay offer the best form of prevention.