Conservative Treatment of Pediatric Bioprosthetic Valve Bacterial Endocarditis

Bioprosthetic valve endocarditis is a major risk of heart valve surgery carrying a high mortality rate.

Although a surgical approach is considered as primary treatment, some evidence shows conservative treatment can be sufficient in selected patients.

We present a series of cases of bacterial bioprosthetic valve endocarditis in children with congenital heart disease with cardiac homograft and biologic valve (Melody valve) implantation. They were treated in a conservative approach without surgical intervention at Soroka medical center. Diagnosis was made according to Duke’s criteria.

Pathogens identified in blood cultures were: Streptococcus Abiotrophia defectiva, Methicillin-resistant Staphylococcus aureus, and Streptococcus Viridans. Treatment included a long course of parenteral antibiotics under close cardiologic follow-up.

All patients had full resolution of symptoms without residual graft dysfunction.

We suggest conservative treatment may lead to equivalent outcomes and may be considered in selected pediatric patients with bioprosthetic valve endocarditis, decreasing potential risks and complications of surgical intervention.