Over the last 30 years, 94 episodes of infectious endocarditis have been identified in 86 children seen at the Children's Hospital of Pittsburgh. In most of these children no precipitating event could be documented. There was no change in underlying cardiac anomalies over the three decades of this study, and left ventricular outflow tract obstruction, ventricular septal defect and tetralogy of Fallot were the most common anomalies. Streptococci and staphylococci were the most common infecting organisms, and there was a slight increase in the percentage of streptococci in the last decade. Cardiovascular damage occurred in about one-third of the cases, and aortic regurgitation was most common. Mitral regurgitation was also an important complication, as was the development of an aortic aneurysm. Important systemic and pulmonary emboli were rare. Surgical intervention was necessary in one-fifth of the children. Valvar replacement was the most common procedure done. The mortality rate declined markedly over the period of the study, dropping from 36% in the first decade to 8% in the last.
