Late infectious endocarditis of surgical patch closure of atrial septal defects diagnosed by 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT): a case report

Abstract

BackgroundIn contrast to percutaneous atrial septal occluder device, surgical patch closure of atrial defects was known to be no infective endocarditis risk.Case presentationWe herein report the first case of late endocarditis of surgical patch closure of atrial septal defects occurred at 47-year after surgery. On September 2014, a 56-year-old immunocompetent French Caucasian man was admitted into the Emergency Department for 3-week history of headache, acute decrease of psychomotor performance and fever at 40 °C. The diagnosis has been evoked during his admission for the management of a brain abscess and confirmed using 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT). Bacterial cultures of surgical deep samples of brain abscess were positive for Streptococcus intermedius and Aggregatibacter aphrophilus as identified by the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry and confirmed with 16S rRNA gene sequencing. The patient was treated by antibiotics for 8 weeks and surgical patch closure removal.ConclusionsIn summary, late endocarditis on surgical patch and on percutaneous atrial septal occluder device of atrial septal defects is rare. Cardiac imaging by the 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT) could improve the diagnosis and care endocarditis on surgical patch closure of atrial septal defects while transthoracic and transesophageal echocardiography remained difficult to interpret.

Challenges and Insights in Aggregatibacter aphrophilus endocarditis: a review of literature

“… No No Blood culture (-) TEE (+) TTE (+) Large weakly echogenic MV veg. Native 1.5 x 1.0 cm Posterior mitral valve CRO, 6 weeks MVR with bioprosthetic valve No 13 ( 15 2016 56/M Headache, acute decrease in psychomotor function, and fever of 40° C. 9 years: closure of ASDs by patent foramen ovale with surgical patch. Cerebral abscess Blood culture (-) TTE (-) TEE (+) High right left shunt confirming dehiscence of the surgical patch closure of ASDs.…”

“…We have reviewed 20 cases (15 men (75%) and 5 women (25%)); median age: 46,8 years old (range 5-74 years) of Aggregatibacter aphrophilus endocarditis reported in the medical literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . The data on gender, age, clinical features, diagnostic tests, surgical treatment, and survival are summarized in Table 1.…”

Streptococcus intermedius Brain Abscess with Lung Abscess and Aortic Valve Endocarditis: A Case Report and Literature Review

“…Streptococcus intermedius has been frequently associated with brain and liver abscesses, in rare cases related to endocarditis or congenital heart diseases [ 3 , 4 , 5 , 6 , 7 , 8 ]. Pleuropulmonary infections by this agent are uncommon [ 9 ], but are increasingly recognized.…”

Surgical Atrial Septal Patch Endocarditis in a Patient with a Complete Corrected Atrioventricular Canal Defect: A Case Report and Review of the Literature

“…Previously, surgical closure was the standard of care for ASD, but over the last 30 years, transcatheter devices have rapidly emerged as the gold standard for ostium secundum ASD [6]. Infectious complications of atrial septal occluder devices represents about 0.1% of cases [7]. The risk of infectious endocarditis on the surgical patch is usually related to the time of surgery; the risk is higher in the first 3 months.…”