Late Infective Endocarditis of an Atrial Septal Occluder Device Presenting as a Cystic Mass

Abstract

We report an atypical echocardiographic presentation of a vegetation in a patient with late infective endocarditis of an atrial septal defect (ASD) occluder device. Transesophageal echocardiography demonstrated a penduculated mass attached to the left atrial side of the occluder device. This mass presented as an oscillating echo free area surrounded by a membrane attached to the device by a thin stalk. At time of surgical excision, the lesion did not present as a spherical cyst. It was assumed that the content of the echo free mass had already emptied into the left atrium. Histopathology diagnosed the mass as a vegetation. The contribution of contrast echocardiography to the evaluation of intracardiac masses is briefly discussed.

Subacute Endocarditis of an Atrial Septal Closure Device in a Patient With a Patent Foramen Ovale

“…Making the diagnosis of endocarditis in these patients can be challenging and frequently requires transesophageal echocardiography [8][9][10]. In this patient, endocarditis was suspected, but the initial transthoracic echocardiogram was negative.…”

“…Since that time, with the development of new atrial septal occluder devices, transcatheter closure of PFOs in adults has increased substantially. In the two reported patients with a PFO who had endocarditis, both had an atrial septal aneurysm, although with such a small number of cases, it is unknown whether that was contributory [8,10]. In the two reported patients with a PFO who had endocarditis, both had an atrial septal aneurysm, although with such a small number of cases, it is unknown whether that was contributory [8,10].…”

“…Although the overall serious complication rate is approximately 15% to 20%, with atrial fibrillation and bleeding being the most common [2][3][4], infectious complications are exceedingly rare [5][6][7][8][9][10], and most of the reported cases are in patients who had a true atrial septal defect as opposed to a PFO. The risk of complications such as thrombosis and infection is thought be primarily related to the exposure of the prosthetic material and thus occurs either before endothelialization occurs or in poorly endothelialized devices [6][7][8][9][10]. Contrary to other reported cases, the device in this patient was completely endothelialized.…”

Late Infection of an Atrial Septal Defect Closure Device: A Possible Complication

“…Only 5 cases (3 adults and 2 infants) have been reported in the literature. [3][4][5] Clinical presentations are variable, including fever, sepsis, general malaise, positive blood culture, and peripheral and cerebral emboli with confusion. Our patient presented with confusion and fever.…”

“…In one large survey, only 3 of 882 patients with a secundum ASD had a history of endocarditis. 2 The incidence of ASD occluder infection is also low, ranging from 0% to 1% in larges series, 3 and most of them occur early (< 6 months) after implantation.…”