1. Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment
- Author
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Brian A. Palafox, Richard N. Gates, Allan K. Nguyen, Joanne P. Starr, and Farbouch Berdjis
- Subjects
Male ,Reoperation ,Staphylococcus aureus ,medicine.medical_specialty ,Prosthesis-Related Infections ,Adolescent ,Septal Occluder Device ,Case Reports ,030204 cardiovascular system & hematology ,Transesophageal echocardiogram ,Asymptomatic ,Heart Septal Defects, Atrial ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Internal medicine ,medicine ,Humans ,Endocarditis ,cardiovascular diseases ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Device Removal ,medicine.diagnostic_test ,business.industry ,Amplatzer Septal Occluder ,Granulation tissue ,Endocarditis, Bacterial ,Staphylococcal Infections ,medicine.disease ,Anti-Bacterial Agents ,Surgery ,medicine.anatomical_structure ,Cardiology ,Chills ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies ,Forecasting - 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.
- Published
- 2016