F.: Endocarditis complicating open-heart surgery. Circulation

ing intracardiac surgery for congenital defects with use of extracorporeal circulation is a new entity, as old only as open intra-cardiac surgery. The reported experience is therefore meager. Suggestions regarding its pathogenesis, recognition, behavior, manage-ment, and prevention are few. Heins and Lindel reported five cases of bacterial endocarditis in a series of 205 heart defects repaired with extracorporeal circu-lation. They stress the facts that the classical signs usually associated with bacterial endo-carditis are absent and that the bacterial flora encountered is unusual and frequently antibiotic resistant. Two of their patients acquired their infection with achromobacter from a contaminated heart-lung machine when ethylene oxide sterilization rather than autoclaving was employed. One of their five cases died. Of additional interest, fever occur-ring shortly after surgery was the only clue that ultimately led to diagnosis. Mandel et al.2 first reported a case of bac-terial endocarditis following repair of an interventricular septal defect. The operation was performed under hypothermia and coro-nary perfusion. The infecting organism was Staphylococcus aureus, and the patient died. Their review of the literature revealed 30 cases of endocarditis following operations for repair of congenital and acquired cardiac lesions but none of these was done with extra-corporeal circulation. Teitel and Florman3 reported an unusual case of Pseudomonas aeruginosa infection on a silk suture used in the repair of an atrial septal defect with extracorporeal circulation. The infection resisted medical therapy unti