Infective endocarditis of transcatheter atrial septal occluder devices: A case report

Infective endocarditis (IE) is caused by bacterial vegetation in valves, but it can also occur in implanted mechanical devices. We report a rare case of IE occurring at the site of percutaneous atrial septal closure devices in a patient in her 50s that had been placed for residual defects on a closure patch in her childhood for an atrial septal defect (ASD). She also had a medical history of distal pancreatectomy for insulinoma in her 40s and had insulin-dependent diabetes mellitus, which means she had been immunocompromised. She visited our hospital with complaints of fever and lumbar pain. A computed tomography scan revealed liver abscess. In blood, urine, and drainage specimens submitted for culture testing, extended spectrum beta-lactamase-producing Escherichia coli was cultured in all specimens. Echocardiography showed vegetation at the atrial septal closure devices. In accordance with IE therapy, removal of the atrial septal patch and closure device was performed after antibiotic treatment for 6 weeks. Because the atrial septal patch was calcified and the two devices implanted on the patch were not well covered by neointima, bacteria could easily form vegetation. Percutaneous residual ASD closure on an atrial patch, especially for immunocompromised hosts, should be carefully considered. LEARNING OBJECTIVE: In general, neointima forms and coats a closure device several years after its insertion. However, as in the present case, the closed atrial septal patch may be severely calcified and the neointima may not be sufficiently formed on the closure device, and infective endocarditis may occur at the site of implantation. In some cases, the indication for closure device implantation after atrial septal patch closure should be carefully considered.