Incidence of Bacterial Endocarditis

BACTERIAL ENDOCARDITIS has been well recognized as an important complication of congenital heart disease, although its incidence has been represented by figures that lack authenticity. Since the ventricular septal defect is the most common form of congenital heart defect, it is important to assess the true incidence of bacterial endocarditis in this lesion. The need has become more urgent since it has been recommended that the surgical closure of a small ventricular septal defect be undertaken because of the possible risk of developing bacterial endocarditis at some time in the future. The evaluation of the problem requires a full knowledge of the natural history of the ventricular septal defect. While this is not completely clarified as yet, an approximate estimate can be made on the available data. It has been recognized that some patients die in infancy; some develop progressive pulmonary vascular disease (Eisenmenger complex), and a significant number have spontaneous closure of the defect. Population studies of Rose and Keith' seem to suggest that in more than half of the population with ventricular septal defects the defects persist into adult life and many of these appear to have a benign prognosis at least in the early adult years. Since the majority of patients survive childhood, it is evident that a relatively large number of such children are therefore potential candidates for subacute