Ten of the 34 patients required reoperations at a later time. The increasing prevalence of transcatheter placement of devices such as septal or vascular occluders and coils pro- vides another potential risk factor for IE, particularly in the early postdeployment period before endothelialization has Although a long-term study of transcatheter closure of atrial septal defects19 showed no cases of IE, several case reports of endocarditis related to transcatheter device treat- ment of atrial and ventricular septal defects and patent ductus arteriosus do suggest that residual defects after device place- ment may be a factor in the risk for IE.20 23 IE in Newborn Infants In a recent multicenter review, 7.3% of cases of pediatric IE (108 of 1480) were diagnosed in the first month of life.24 Improved and widely available imaging technology, particu- larly echocardiography, and increased clinical awareness have greatly facilitated the diagnosis of IE in this patient group. The incidence of neonatal IE has increased in the past 2 decades in large measure because of the increasing use of invasive tech- niques to manage neonates with multiple complex medical problems, even those with structurally normal hearts. Central venous catheters designed to be in place for prolonged peri- ods of time, such as peripherally inserted central catheters and tunneled central venous catheters, provide a portal of entry for surface bacterial despite the most meticulous management. As a result of the indwelling lines, infections frequently involve right-sided heart structures. It has been estimated that fewer than one-third of cases of neonatal endocarditis occur in the presence of congenital cardiac disease.24 26 A recent review showed that 31% of infants who died of IE were premature.24 The most common infecting organisms were S aureus, coagu- lase-negative staphylococcus strains, Gram-negative bacterial species, and Candida species. 