JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, NO.

22, 2018

ª 2018 PUBLISHED BY ELSEVIER ON BEHALF OF THE

AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

IMAGES IN INTERVENTION

Infective Endocarditis of Patent Foramen

Ovale Closure Device Presenting as an
Amoeboid-Like Mass
Hidenaru Yamaoka, MD,a Yoichi Takaya, MD,a Nobuhisa Watanabe, RDCS,b Teiji Akagi, MD,a Koji Nakagawa, MD,a
Norihisa Toh, MD,a Yasuhiro Kotani, MD,c Shingo Kasahara, MD,c Hiroshi Ito, MDa

A 73-year-old woman presented with fever and

Janeway lesions on her palms. She had un-
dergone transcatheter patent foramen ovale
closure with a 30-mm Amplatzer Cribriform device
F I G U R E 1 Transesophageal Echocardiography

(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. Trans-
thoracic 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 sur-
rounded by a membrane (Figure 1, Online Video 1).
Urgent surgery was performed. The incomplete endo-
thelialization and mass on the right atrial disc were
Transesophageal echocardiography shows the mobile mass
found (Figure 2A). During an incision through the (Online Video 1).
septum, the purulent matter flowed out of the highly

From the aDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharma-
b
ceutical Science, Okayama, Japan; Division of Medical Support, Okayama University Hospital, Okayama, Japan; and the
c
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science,
Okayama, Japan. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Manuscript received June 14, 2018; accepted June 26, 2018.

ISSN 1936-8798/$36.00 https://doi.org/10.1016/j.jcin.2018.06.055

2338 Yamaoka et al. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, NO. 22, 2018

Infective Endocarditis of Patent Foramen Ovale Closure Device NOVEMBER 26, 2018:2337–8

F I G U R E 2 Intraoperative View

Intraoperative view shows the incomplete endothelialization and mass (A), the purulent matter (arrow) (B), and the ruptured mass (arrow) (C).

mobile mass on the left atrial surface (Figure 2B). The antibiotic prophylaxis is necessary at any time to
ruptured mass was observed (Figure 2C). prevent the infection of device.
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 ADDRESS FOR CORRESPONDENCE: Dr. Yoichi
phase after device implantation. Antibiotic prophy- Takaya, Department of Cardiovascular Medicine,
laxis is recommended for 6 months after device im- Okayama University Graduate School of Medicine,
plantation because complete endothelialization is Dentistry and Pharmaceutical Science, 2-5-1 Shikata-
considered to occur at 3 to 6 months. However, its cho, Kitaku, Okayama 700-8558, Japan. E-mail:
confirmation is impossible. Our case suggests that takayayoichi@yahoo.co.jp.

REFERENCE

1. Amedro P, Soulatges C, Fraisse A. Infective

endocarditis after device closure of atrial septal KEY WORDS infective endocarditis, AP PE NDIX For a supplemental video,
defects: case report and review of the literature. patent foramen ovale, transcatheter closure please see the online version of this paper.
Catheter Cardiovasc Interv 2017;89:324–34.