Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment

Tex Heart Inst J. 2016 Jun 1;43(3):227-31. doi: 10.14503/THIJ-14-4949. eCollection 2016 Jun.

Abstract

A 4-year-old boy had a 15-mm atrial septal defect repaired percutaneously with use of an Amplatzer Septal Occluder. At age 16 years, he presented with a week's history of fever, chills, dyspnea, fatigue, and malaise. Cultures grew methicillin-sensitive Staphylococcus aureus. A transesophageal echocardiogram showed a 1.25 × 1.5-cm pedunculated mass on the left aspect of the atrial septum just superior to the mitral valve, and a smaller vegetation on the right inferior medial aspect of the septum. At surgery, visual examination of both sides of the septum revealed granulation tissue, the pedunculated mass, the small vegetation, and exposed metal wires that suggested incomplete endothelialization of the occluder. We removed the occluder and patched the septal defect. The patient returned to full activity after 4 months and was asymptomatic 3 years postoperatively. Our report reinforces the need for further investigation into prosthetic device endothelialization, endocarditis prophylaxis, and recommended levels of physical activity in patients whose devices might be incompletely endothelialized. In addition to reporting our patient's case, we review the medical literature on this topic.

Keywords: Biocompatible materials/metabolism; cardiac catheterization/instrumentation; endocarditis, bacterial/etiology/pathology/prevention & control; endothelial cells/metabolism; heart defects, congenital/therapy; heart valve prosthesis implantation/adverse effects/instrumentation/methods; prosthesis-related infections/etiology/therapy; septal occluder device/adverse effects; time factors; treatment failure.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Cardiac Surgical Procedures / methods
  • Device Removal
  • Echocardiography, Transesophageal
  • Endocarditis, Bacterial / diagnosis
  • Endocarditis, Bacterial / etiology*
  • Endocarditis, Bacterial / therapy
  • Follow-Up Studies
  • Forecasting*
  • Heart Septal Defects, Atrial / diagnosis
  • Heart Septal Defects, Atrial / surgery*
  • Humans
  • Male
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / etiology*
  • Prosthesis-Related Infections / therapy
  • Reoperation
  • Septal Occluder Device / adverse effects*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / etiology*
  • Staphylococcal Infections / therapy
  • Staphylococcus aureus / isolation & purification*

Substances

  • Anti-Bacterial Agents