Infective endocarditis in pediatric patients: an eighteen-year experience from 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. MATERIAL AND METHOD: From January 1987 to December 2004, 57 pediatric patients; 28 females and 29 males, 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 demonstrated vegetations in 56 patients (98%). The location of the vegetations was in the right heart in 30 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 > or =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.

Selection of coil for transcatheter closure of small patent ductus arteriosus.

The authors reported the results in transcatheter coil occlusion of patent ductus arteriosus (PDA) less than 4 mm, based on a policy in selection of the appropriate type and number of coils for size of PDA. The authors used one 0.035 inch detachable coil, 5 mm in diameter, in PDA less than or equal to 2 mm, and two 0.035 inch detachable coils or one controlled release 0.052 inch Gianturco coil in PDA larger than 2 mm. The present study included 32 pediatric patients. There were 31 cases of successful coil implantation and 1 case failed. Of the 31 successful cases, PDA size varied from 1.4 to 4.0 mm (mean of 2.7 +/- 0.9 mm). Ten patients had a PDA size of less than or equal to 2 mm (group A), while the other 21 patients had a PDA size of larger than 2 mm (group B). In group A, 9 cases had single-detachable-coil occlusion and one case had double-detachable-coil occlusion. In group B, double-detachable-coil occlusion was performed in 17 cases and controlled release 0.052 inch coil in 4 cases. There were no cases of coil migration or other serious complications. The immediate complete occlusion rate was 58 per cent (18 of 31 cases), which rose to 97 per cent (30 of 31 cases) at the mean follow-up of 2.6 +/- 2.5 months (range from 1 day to 9 months). Transcatheter coil occlusion is an alternative to surgical closure of small PDA (less than 4 mm). Selection of type and number of coils appropriate to the size of PDA will allow safe and excellent results.