Surgical problems of endocarditis in children.

Among 143 episodes of endocarditis experienced in children over a 38-year period from 1950 to 1988, 23 patients required surgical intervention, including 11 valve replacements, 2 valve repairs, 7 mycotic aneurysm resections (most related to coarctation or ductus), and 3 instances of debridement and repair of the ventricular septum. Left-sided vegetations associated with endocarditis have traditionally been managed surgically only if repeated emboli have occurred. Following the unfavorable outcome in several patients with large mobile vegetations on the mitral valve, we have adopted a more aggressive surgical approach to debride and repair left-sided valves involved with such vegetations.