Early-to-mid onset bacterial endocarditis following implantation of Gore Cardioform Septal Occluder device.

Abstract

We present the unusual case of a 37-year-old female who was found to have bacterial endocarditis related to a 30 mm Gore Cardioform Septal Occluder that was placed following multiple paradoxical strokes, due to a patent PFO. Cardiothoracic Surgery was consulted and patient underwent surgical explantation with pericardial patch repair. Patient was discharged on postoperative (POD) 10 with 6 weeks of IV Cefazolin. Endocarditis following PFO closure-device implantations remains an exceedingly rare complication. In those that do develop endocarditis, the majority occur in early postop period. The first 3 months following implantation is where the subject is at greatest risk of endocarditis, owing to incomplete endothelialization of the implantable device. Late-onset endocarditis (>6 months postop) has also been documented in the literature. Thus, while current literature recommends prophylactic antibiotic administration prior to invasive surgery during the first 6 months following device implantation, prolonging this period may be indicated in select high-risk populations.