Infective endocarditis in children: native valve preservation is frequently possible despite advanced clinical disease
Bibliographic record
Abstract
BACKGROUND: Recent reports describing surgical experiences with childhood IE are sparse. We sought to determine patient-specific characteristics and their impact on outcome for children with infective endocarditis (IE) undergoing surgical intervention. We therefore reviewed all cases of culture-proven IE referred for surgical intervention at our institution over the last three decades. METHODS: Of 15,124 cardiovascular surgical procedures performed between 1978 and 2007 at our institution on children under the age of 18, only 30 (0.2%) were undertaken for a primary diagnosis of IE. All 30 children underwent chart review and retrospective risk-hazard analysis. RESULTS: Median patient age was 9.8 years (range 10 weeks to 17.5 years). Underlying congenital cardiac lesions were present in 22 (77%) and previous intra-cardiac repair in 9 (30%). Septic emboli occurred in 13 (46%), causing permanent strokes in 4 (14%). Streptococcus viridans and Staphylococcus aureus were the predominant organisms. S. viridans was associated with underlying congenital lesions (p<0.01). S. aureus was associated with abscess formation (p<0.03), clinical sepsis (p<0.04), acute deterioration (p<0.01), prolonged hospitalization (p<0.01) and death (p<0.01). Aortic, mitral and tricuspid valves were involved with equal frequency, more than the right ventricular outflow tract. Two valves were involved in 30%. The native valve was preserved at operation in 22 (73% cases). Univariate predictors for valve replacement included increased leaflet thickening (p<0.01) and occurrence of septic embolization (p=0.02), whereas moderate/severe valvular regurgitation was not significant. Five-year freedom from IE-related death and re-intervention was 84% and 80%, respectively. At latest follow-up 96% of patients are NHYA I. CONCLUSIONS: Children undergoing surgery for infective endocarditis frequently have advanced disease with embolic complications and double valve involvement. However, preservation of the native valve is frequently possible. Need for valve replacement is suggested by leaflet thickening and embolization. Despite the advanced pathology, survival and functional outcomes are favorable.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".