Publication Date
6-1-2016
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-14-4949
PMID
27303238
Publication Date(s)
June 2016
Language
English
PMCID
PMC4894701
PubMedCentral® Posted Date
6-1-2016
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
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
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
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.