Surgical Management of Infective Endocarditis in Patients with Non-Valvular Congenital Heart Diseases

The aim of the investigation was to develop the surgical management of infective endocarditis in patients with non-valvular congenital heart diseases. Materials and Methods. 31 patients with non-valvular congenital heart diseases complicated by infective endocartitis were operated in Nizhny Novgorod Specialized Cardiological Clinical Hospital from 1993 till 2011. The patients’ age varied from 4 months to 37 years. Among non-valvular defects there were vegetations of mural endocardium and endothelium of major arteries, infected erosions, thrombi; and most frequently they developed in patients with ventricular septal defect (19 patients), valvular and infundibular pulmonary artery stenosis (3 patients), coronaro-right-ventricular fistula (3 patients), Fallot’s tetrad (2 patients), a patent arterial duct (2 patients). In two cases infection developed in patients with the previous plasty of septal defects and was accompanied by their recanalization.Results. Four patients died in early postoperative period. The mortality rate was 12.9%. Three patients died of progressive acute heart failure, and one — of major postoperative bleeding. 19 patients managed to avoid heart valve replacement due to a timely surgery performed before gross destructive cardiac valve damage developed. In 12 patients one of cardiac valves was replaced due to a late operation and a highly active infectious process. Conclusion. Early surgery enables to improve treatment results and save the cardiac valvular apparatus. Recanalization of septal defect against the background of the developed infective endocarditis is to be considered an indication for surgical sanitation of cardiac chambers and repeated plasty of congenital heart disease. Surgical approach to different types of congenital malformations against the background of infective endocarditis is patient-centered, though the general principle is the maximum correction of turbulent blood flows contributing to endocardial damage and persistent infection, with minimal use of synthetic materials and conduits.