Successful treatment of infective endocarditis with recombinant tissue plasminogen activator.
OBJECTIVE
In a prospective study, we examined the effect of treatment with recombinant tissue plasminogen activator (r-TPA) on survival and morbidity in a series of high-risk children with infectious endocarditis (IE) after prolonged treatment with indwelling catheters. We hypothesized that r-TPA is an adjunctive therapy for dissolution of infected thrombi in drug-resistant IE.


METHODS
In the prospective 3-year study (1998-2001), we identified high-risk children with chronic illness and prolonged treatment with indwelling catheters who developed IE and overwhelming sepsis. Patients were allocated to receive r-TPA after persistent and enlarging intracardiac vegetations and failure to respond to conventional medical management. Complications associated with treatment, survival, and cardiac morbidity were observed.


RESULTS
Seven infants were treated prospectively with r-TPA. All infants responded promptly to treatment, with resolution of the intracardiac vegetations within 3 to 4 days of commencement and without any adverse complications. All patients survived without long-term cardiac morbidity.


CONCLUSIONS
Recombinant tissue plasminogen activator may offer a safe alternative to surgical intervention in the high-risk infant with IE.
Levitas
Aviva
A
Department of Pediatric Cardiology, the Pediatric Intensive Care Unit, Faculty of Health Sciences, Ben-Gurion University, Soroka Medical Center, Beer Sheva, Israel. alevitas@bgumail.bgu.ac.il
Zucker
Nili
N
Zalzstein
Eli
E
Sofer
Shaul
S
Kapelushnik
Joseph
J
Marks
Kyla A
KA
D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator