Diseases & Conditions
An infection of the lining of the heart that may occur in any infant or child, whether or not there is any heart disease present. Bacterial endocarditis does not occur very often, but when it does, it can cause serious heart damage, so it is important to prevent this infection if possible.
Bacterial endocarditis is caused by bacteria that enter the blood, lodging inside the heart where they multiply and cause infection. A normal heart has a smooth lining that is hard for bacteria to attach to, but children with congenital heart disease may have a roughened area on the heart lining caused by pressure from an abnormal opening or a leaky valve. Even after surgery, roughened areas may remain as a result of scar tissue formation or patches used to redirect blood ﬂow. These rough areas make perfect places for bacteria to build up and multiply.
Bacteria that cause this problem may get into the blood during dental procedures, tonsillectomy, or ADENOIDECTOMY, examination of the respiratory passageways with a rigid bronchoscope, or during certain types of surgery on the respiratory passageways, the gastrointestinal tract, or the urinary tract.
Any infant or child who has congenital heart disease that has not yet been repaired can develop bacterial endocarditis. Some children who have already had a heart defect repaired may also need to take precautions against bacterial endocarditis for the rest of their lives, while others may no longer need to observe these precautions. Heart problems that put children at risk for developing bacterial endocarditis include mitral valve prolapse, having artiﬁcial heart valves, a previous history of endocarditis, complex cyanotic congenital heart disease due to insufﬁcient oxygen in the blood, and surgically constructed systemic pulmonary shunts. Other heart problems linked to endocarditis may include acquired valve dysfunction, such as is due to rheumatic heart disease or collagen vascular disease, or an enlarged heart muscle that causes impeded blood ﬂow.
In addition to a complete medical history and physical examination of the child, diagnostic procedures may include echocardiogram, a complete blood count (CBC), and a blood culture to assess the speciﬁc type of bacteria in the bloodstream, if any.
Helping children maintain excellent oral hygiene is an important step in preventing bacterial endocarditis. Regular visits to the dentist for professional cleaning and checkups are essential. Proper oral hygiene is crucial, including regular brushing and ﬂossing.
One dose of an antibiotic is often given prior to any procedure that would put a child at risk with a follow-up dose six hours after the procedure. In most cases, the antibiotics can be given by mouth.
Speciﬁc treatment is based on the child’s age, overall health, and medical history; the extent and cause of the infection; the child’s tolerance for procedures or treatments; and how the child’s doctor expects the infection to progress. In most cases, the infection is treated with strong antibiotics given through an IV over the course of several weeks. However, heart damage may still occur before the infection can be controlled.