Mitral Valve Endocarditis in a Pediatric Patient: When Is the Right Time to Intervene? A Case Report

Infective endocarditis (IE) is most often treated conservatively with medical management. There are no clear guidelines in the pediatric population for timing of surgical intervention. This is a case report of an 18-month-old male admitted to the hospital with IE. His workup showed a large vegetation on the mitral valve with evolving regurgitation caused by Kingella kingae, a HACEK group organism. Factors that led to consideration for early surgical intervention included the size of the vegetation (19 mm), the etiologic agent (K. kingae) described to be associated with a high rate of complications, the absence of neurologic complications, and the possibility for valve-sparing repair strategies. Following mitral valve repair, the patient made an uneventful recovery and he was discharged home within a week, to complete a course of antibiotics. Surgical intervention early in the disease course of IE can be a safe option and could pre-empt the development of embolic complications especially in the setting of very large vegetations and certain types of high-risk organisms. Additionally, early surgery allows for valve repair and could avoid valve replacement with its attendant risk of anticoagulation therapy and future surgery.