From pelvis to heart: A rare case of infective endocarditis following ASD device closure due to tubo-ovarian abscess.

UNLABELLED: Infective endocarditis (IE) following transcatheter atrial septal defect (ASD) device closure is a rare but life-threatening complication. We report a case of a 41-year-old woman who developed device-related IE five months after ASD closure, likely secondary to an undiagnosed tubo-ovarian abscess. Initially evaluated for abnormal uterine bleeding, she was diagnosed with uterine fibroids and endometriosis. Pre-anesthetic cardiac assessment revealed a large secundum ASD, which was successfully closed with a 48-mm atrial septal occluder. Despite an uneventful early post-procedure course, her worsening uterine bleeding led to clopidogrel discontinuation. Five months later, she presented with high-grade fever and chills, and echocardiography revealed mobile vegetations on the inferior aspect of the device. A tubo-ovarian abscess was identified as a potential source of infection. Surgical abscess drainage failed to resolve symptoms, necessitating device removal and surgical ASD closure with a pericardial patch. Histopathology confirmed vegetation, although no microorganisms were isolated. This case underscores the need for vigilance in diagnosing IE post-ASD device closure, particularly in patients with distant infections. Negative blood cultures do not exclude IE, and echocardiography is crucial. A multidisciplinary approach, including prompt surgical intervention and prolonged antibiotics, ensures optimal outcomes. Long-term follow-up is essential to prevent recurrence.

LEARNING OBJECTIVE: This case highlights the critical learning objective of recognizing and managing rare but serious complications such as infective endocarditis following atrial septal defect device closure. It emphasizes the importance of considering distant infection sources, such as tubo-ovarian abscesses, in patients presenting with post-procedural complications. Furthermore, it underscores the necessity of multidisciplinary collaboration, and prolonged antibiotic therapy and surgical intervention for successful patient outcomes.