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Sterile vegetations in children with severe tetralogy of Fallot

  • Antoinette M. Cilliers (a1), Kathy M. Vanderdonck (a1), Jan P. du Plessis (a1), Stefanus L. Cronje (a1) and Solomon E. Levin (a1)...


The finding of bland, sterile vegetations in children with severe tetralogy of Fallot is unexpected, and to our knowledge, has not been reported previously. Eight patients diagnosed with tetralogy between January 1993 and July 1997 had sterile vegetations proven by histological and microbiological evaluation, in their right ventricular outflow tracts. Four of these patients were experiencing severe hyper-cyanotic spells, and four had severely reduced effort tolerance at presentation. They all underwent cardiac catheterization and were submitted for surgical repair. At surgery, the vegetations were thought to be causing further narrowing of the already tight fibrotic infundibular stenosis. Two of these patients had evidence of damaged valves, without evidence of active endocarditis. Although initially sterile, these vegetations, may in some instances, become infected.


Corresponding author

Professor S. E. Levin, Johannesburg Hospital, Department of Paediatrics & Child Health, Private Bag X39, Johannesburg, South Africa. Tel: 27 11 488 3191; Fax: 27 11643 1612


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1.Geva, T, Frand, M: Infective endocarditis in children with congenital heart disease; the changing spectrum, 1965–85. Eur Heart J 1988; 9: 12441249.
2.Gilbert, BW, Haney, RS, Crawford, F, McClellan, J, Gallis, HA, Johnson, ML, Kisslo, JA. Two-dimensional echocardiographic assessment of vegetative endocarditis. Circulation 1977; 55: 346353.
3.Livornese, LL, Korzeniowski, OM. Pathogenesis of infective endocarditis. In: Kaye, D, ed. Infective Endocarditis. Raven Press, New York , 1992 pp.1935.
4.Lepeschkin, E. On the relationship between the site of valvular involvement in endocarditis and the blood pressure resting on the valve. Am J Med Sci 1952 ; 224: 316319.
5.Scheld, WM. Pathogenesis and pathophysiology of infective endocarditis. In: Sande, MA, Kaye, D, Root, RK, eds. Endocarditis. Contemporary Issues in Infectious Diseases. Churchill Livingstone, London, 1984, pp 132.
6.Bisno, AL, Dismukes, WE, Durack, DT, Kaplan, EL, Karchmer, AW, Kaye, D, Rahimtoola, SH, Sande, MA, Sanford, JP, Watanakunakorn, C, Wilson, WR.Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci. JAMA 1989; 261: 14711477.
7.Kaplan, EL, Shulman, ST. Endocarditis. In: Adams, FH, Emmnouilides, GC, Riemenschneider, TA, eds. Moss' Heart Disease in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, 1989 pp.718730.
8.Freedman, LR, Valone, J.Experimental infective endocarditis. Prog Cardiovasc Dis 1979; 22:169180.
9.Kirklin, JW, Barratt-Boyes, BG. Ventricular Septal Defects and Pulmonary Stenosis or Atresia. In Kirklin, JW, Barratt-Boyes, BG, eds. Cardiac Surgery. Churchill Livingstone, New York, 1993 pp 863973.



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