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(Circulation. 2008;117:e326-e327.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Incomplete Endothelialization and Late Development of Acute Bacterial Endocarditis After Implantation of an Amplatzer Septal Occluder Device

Timothy C. Slesnick, MD; Alan W. Nugent, MD; Charles D. Fraser, Jr, MD; Bryan C. Cannon, MD

From the Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital and the Baylor College of Medicine (T.C.S., A.W.N., B.C.C.), and the Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine (C.D.F.), Houston, Tex.

Reprint requests to Timothy C. Slesnick, MD, 6621 Fannin Ave, MC 19345-C, Houston, TX 77030. E-mail slesnick@bcm.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 4-year-old girl with a history of a moderate-sized secundum atrial septal defect and mild mitral valve prolapse underwent transcatheter closure with a 22-mm Amplatzer septal occluder (ASO) (AGA Medical Corporation, Golden Valley, Minn) device. Approximately 12 months later, she presented to the emergency department in septic shock with a 5-day history of fevers up to 105°F and was transferred to the pediatric intensive care unit. Her blood and urine cultures grew methicillin-sensitive Staphylococcus aureus within 24 hours. Multiple septic emboli were found on a brain magnetic resonance imaging scan.

A transthoracic echocardiogram revealed vegetations on the mitral and tricuspid valves (Figures 1 and 2 and Movies I and II), with a perforation in the mitral valve and severe mitral insufficiency. The patient was taken to the cardiovascular operating room, and severe mitral and tricuspid valve endocarditis was confirmed. The ASO device showed only minimal endothelialization (Figure 3) and extensive purulent material was present throughout, with several loculated abscesses adherent to the device (Figure 4). There was a large, windsock-like vegetation on the mitral valve. The mitral valve had several perforations and necrosis of 75% of the anterior leaflet, and the tricuspid valve had a large abscess adherent to the septal leaflet. The ASO device was removed, the mitral valve was repaired, and the defect was closed with pericardium. At the completion of the repair, the patient had mild to moderate mitral regurgitation with no mitral stenosis.

View larger version (133K):   Figure 1. Transthoracic echocardiographic image in the parasternal . . . [Full Text of this Article]