Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment

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.

Infective endocarditis after device closure of atrial septal defects: Case report and review of the literature

“…We selected seven ASD device follow‐up studies , one meta‐analysis of percutaneous and surgical ASD closure , and two FDA databases . We identified twenty‐one cases of infective endocarditis following atrial septal device closure (Table ). Three studies did not meet the selection criteria (fungal endocarditis following ventricular septal defect hybrid procedure , atrial septal defect presenting with Brucella endocarditis , and patch abcess after surgical closure of an atrial septal defect ).…”

Key Regulatory Differentially Expressed Genes in the Blood of Atrial Septal Defect Children Treated With Occlusion Devices

“…One of the most important indicators for evaluating the histocompatibility of the occluder is the endothelialization induced by the occluders. Endothelialization is crucial and of major clinical importance and impaired endothelialization may lead to prolonged anticoagulant therapy and even serious complications such as residual shunt, device-related thrombosis, endocarditis, and occluder displacement ( Chessa et al, 2004 ; Nguyen et al, 2016 ; Kalayc and Kalayc, 2017 ; Chen et al, 2018 ; Li et al, 2020 ). Therefore, the observation of endothelialization after occluder implantation is particularly important.…”

Mobile vegetations on a poorly endothelialized atrial septal defect closure device

“…Although rare, cases of device endocarditis in the late phase up to 12 years have been reported. 1 , 2 , 3 Several articles have demonstrated poor endothelialization after atrial septal defect closure device implantation. 1 , 2 , 3 These findings indicate the continued risks of thrombotic and infectious complications over the long-term in some patients after implantation of an atrial septal defect closure device.…”

“… 1 , 2 , 3 Several articles have demonstrated poor endothelialization after atrial septal defect closure device implantation. 1 , 2 , 3 These findings indicate the continued risks of thrombotic and infectious complications over the long-term in some patients after implantation of an atrial septal defect closure device. Because atopic dermatitis is known as a risk factor for infectious endocarditis, 4 surgical atrial septal closure could offer a good alternative to percutaneous device closure for patients with atopic dermatitis.…”