Late Infective Endocarditis Associated with an Atrial Septal Defect Occluder Device

The Amplatzer septal occluder is one of several percutaneous devices used for the closure of secundum atrial septal defects. The main complications are related to the procedure, with infection being the least common. We present the case of a 67-year-old woman with a secundum atrial septal defect, who, 3 years after repair with an Amplatzer occluder, was admitted with sepsis and bacteraemia following recent hospitalization in an intensive care unit. Transoesophageal echocardiography showed the presence of a mobile echogenic structure in the left atrium suggestive of a vegetation. Few cases of late endocarditis involving the Amplatzer device have been reported, even though partial endothelization is one of the risk factors. There are no guidelines for the prevention, diagnosis or management of this complication. LEARNING POINTS: The Amplatzer septal occluder is one of several alternatives for the closure of atrial septal defects and has few related complications, with infection being the least common. Device-related endocarditis presents either early (<6 months) or late (>6 months). In our case, transoesophageal echocardiography played a key role in the diagnosis of late endocarditis.