Mortality from infectious endocarditis in the general paediatric population had decreased significantly over the last two decades. This is attributable to the increased awareness of the health care team in recognizing the early signs of this once fatal disease such that early antibiotic intervention is possible. Two groups, however, remain at high risk for infectious endocarditis. Advances in cardiac surgery have dramatically improved the prognosis for survival in many children with otherwise fatal congenital heart diseases. This group of children, along with the seriously ill who have central venous catheters in place, are currently at the highest risk for development of infectious endocarditis.1-5

A 29-year-old woman who had tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries developed aortic regurgitation due to infectious endocarditis. Isolated aortic valve replacement was undertaken because of heart failure unresponsive to medical therapy. Excessive flow through the aortopulmonary collateral arteries during cardiopulmonary bypass was controlled by means ofintraaortic balloons which were inflated to occlude the origin of the collateral arteries. Arterial return from the pump was delivered through separate cannulation of the ascending aorta and the right femoral artery. We believe that this method should be considered in those circumstances when excessive flow through systemic-to-pulmonary arteries is expected during cardiopulmonary bypass.