Clinical features and echocardiography characteristics of infective endocarditis in children

doi:10.3877/cma.j.issn.1673-5250.2019.06.011

Objective

To investigate the clinical and ultrasonic cardiogram (UCG) features of children with infective endocarditis (IE).

Methods

A total of 28 IE children diagnosed in West China Second University Hospital, Sichuan University from May 2013 to May 2018, were selected as research subjects, and the clinical case data of them were analyzed retrospectively to summarize the clinical and UCG characteristics. The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013 and informed consents for clinical research were signed with guardians of all children.

Results

① Clinical features: among 28 children with IE, 85.7% (24/28) had fever symptoms; the positive rate of blood culture was 64.3% (18/28), and the most common pathogen was Staphylococcus aureus, which accounted for 33.3% (6/18) in positive blood culture results. ②UCG features: 71.4% (20/28) of children with IE had congenital heart disease. There were intracardiac vegetations in 25 children with IE (89.3%, 25/28), and 2 of them were involved in multiple sites, while the remaining 23 were involved in a single site. Among all children with intracardiac vegetations, mitral valve involvement was the most common, accounting for 40.0% (10/25), and the anterior and posterior mitral leaves were each accounted for 20.0% (5/25). The second place was the pulmonary artery wall near the opening of ductus arteriosus and the aortic valve, which were each accounted for 16.0% (4/25). The highest proportion of heart enlargement was left heart enlargement with proportion of 35.7% (10/28). And 85.7% (24/28) of children with IE had normal left ventricular systolic function. In addition, valve perforation, regurgitation could also be found.

Conclusions

The clinical manifestations of children with IE were diversified and variable, which increased the difficulty of diagnosis. Enhancing the cognition of IE and fully grasping the characteristics of UCG were very important for rapid and accurate diagnosis and early treatment of the disease, so as to improve the prognosis of children with IE.

Key words: Endocarditis, bacterial, Echocardiography, Blood culture, Staphylococcus aureus, Heart defects, congenital, Child

图1 本组1例感染性心内膜炎患儿(男性，9岁)超声心动图声像图(白色箭头所示为二尖瓣赘生物形成)

图2 本组1例感染性心内膜炎患儿(女性，6岁)超声心动图声像图(白色箭头所示为二尖瓣前叶穿孔)

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