Infective endocarditis on a bicuspid aortic valve in a pediatric patient - A case report.
Infective endocarditis on a bicuspid aortic valve in a pediatric patient - A case report.
Stankovikj V*, Jovanovska V**, Chadikovski V***, Martinova K****, Stankovikj S*****, Sofijanova A.******
University Children’s Hospital, Skopje, Republic of Macedonia*, University Children’s Hospital, Skopje, Republic of Macedonia**, University Children’s Hospital, Skopje, Republic of Macedonia***, University Children’s Hospital, Skopje, Republic of Macedonia****, University Children’s Hospital, Skopje, Republic of Macedonia*****, University Children’s Hospital, Skopje, Republic of Macedonia******
Background
Infective endocarditis may be defined as a microbe infection of the inner surface of the heart (the endocardium). It most commonly affects the heart valves leading to formation of small masses at the site of infection, known as vegetations. The latter may lead to serious complications including heart failure development and even death. Regarding the paediatric population, children with an underlying congenital heart defect (CHD) are primarily affected.
Methods
A 9 year-old child with a previously diagnosed bicuspid aortic valve disease and a two-month history of fever is presented. Following detailed clinical, laboratory and echocardiographic evaluation, the child was diagnosed with infective endocarditis.
Results
Echocardiography revealed presence of vegetations on the abnormal aortic valve, a mitral valve cleft as well as dilation of the left heart cavities. Several consecutive blood cultures elucidated the causative microorganism to be MRSA. The child was initially treated with double intravenous antibiotic therapy, followed by surgery, consisting of mechanical aortic valve placement and mitral valvuloplasty. Additionally, an anticoagulant regimen was initiated involving intravenous administration of heparin followed by oral anticoagulant therapy. Early postoperative complications included development of pericardial effusions that necessitated pericardial drainage and further intensive care measures. Late follow up investigations revealed satisfactory functionality of the mechanical device and a significant cardiac function improvement.
Conclusion
Paediatric infective endocarditis can lead to serious complications. It should be taken into account especially in children with an underlying CHD and a history of prolonged fever. Open-heart surgery is often the only treatment option for these children. Therefore, regular follow up evaluations and preventative measures should be carried out in high-risk patients.
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