A remarkable case of late-onset biatrial bacterial endocarditis of the Gore HELEX septal occluder

Abstract

Metaanalyses of trials comparing medical treatment versus surgical closure of patent foramen ovale (PFO) have shown that percutaneous closure is more effective for preventing recurrent thromboembolic events [1]. Common complications of any occluder device include device thrombus formation, transient ischemic attack, pericardial tamponade, device dislocation, arrhythmias, and endocarditis [1]. In this article, we take a closer look at endocarditis post-device implant. It is established that up to 6 months post-implant, there is a high likelihood of device infection because endothelialization is incomplete [2]. Late-onset (>6 months) endocarditis of any occluder device is exceptionally rare. There have been scattered reports of late endocarditis with the popular AMPLATZER (St. Jude Medical, St. Paul, MN, USA) device [2][3][4]. There has been one reported case of late endocarditis with the HELEX septal occluder (W.L. Gore & Associates, Newark, DE, USA)where the patient was treated with open-heart surgery [5]. Here, we present a case of delayed-onset right-and left-sided bacterial endocarditis of the HELEX devicemade even more remarkable by the resounding success of non-surgical management. Case reportA 50-year-old African American man presented to our medical center with weakness, fever, lethargy, and chills. His medical history was significant for a 4 mm PFO that was repaired in 2010 (five years prior to current admission, repair reason unknown), paroxysmal atrial fibrillation, type 2 diabetes mellitus with resultant foot ulcer, hypertension, chronic hepatitis B, chronic

Emerging Concepts on Infection of Novel Cardiac Implantable Devices

“…After extensive literature review, we found 23 reported cases of IE on ASD closure devices (Table 1 , Ref. [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]).…”

“…Median age of subjects with device IE was 37 years and most developed endocarditis beyond 6 months of device implantation (17/23, 78%). Fever was the most common presenting symptom (n = 22/23, 95%), and other presentations included stroke/other site embolism (n = 10/23, 42%, pulmonary embolism in one case [ 56 ]), septic shock (n = 2/23, 8%), immunologic phenomena (n = 3/23, 13%), and acute meningitis (n = 1/23, 4%).…”