Author + information
- Received June 14, 2018
- Accepted June 26, 2018
- Published online November 19, 2018.
- Hidenaru Yamaoka, MDa,
- Yoichi Takaya, MDa,∗ (, )
- Nobuhisa Watanabe, RDCSb,
- Teiji Akagi, MDa,
- Koji Nakagawa, MDa,
- Norihisa Toh, MDa,
- Yasuhiro Kotani, MDc,
- Shingo Kasahara, MDc and
- Hiroshi Ito, MDa
- aDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
- bDivision of Medical Support, Okayama University Hospital, Okayama, Japan
- cDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
- ↵∗Address for correspondence:
Dr. Yoichi Takaya, Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan.
A 73-year-old woman presented with fever and Janeway lesions on her palms. She had undergone transcatheter patent foramen ovale closure with a 30-mm Amplatzer Cribriform device (Abbott, Chicago, Illinois) 6 years before. Two months before onset, she had received dental procedures without antibiotic prophylaxis. Blood cultures grew methicillin-resistant Staphylococcus aureus. Transthoracic echocardiography showed slightly flickered lesions on the left atrial side of the device, but these were unclear. Transesophageal echocardiography showed a 20 × 15-mm highly mobile mass attached to the left atrial surface of the device, which was amoeboid-like. The hypoechoic material was surrounded by a membrane (Figure 1, Online Video 1). Urgent surgery was performed. The incomplete endothelialization and mass on the right atrial disc were found (Figure 2A). During an incision through the septum, the purulent matter flowed out of the highly mobile mass on the left atrial surface (Figure 2B). The ruptured mass was observed (Figure 2C).
Infective endocarditis of a closure device is extremely rare (1). Our case highlights that infection of the device should be suspected even at the late phase after device implantation. Antibiotic prophylaxis is recommended for 6 months after device implantation because complete endothelialization is considered to occur at 3 to 6 months. However, its confirmation is impossible. Our case suggests that antibiotic prophylaxis is necessary at any time to prevent the infection of device.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 14, 2018.
- Accepted June 26, 2018.