{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:20:31Z","timestamp":1787840431457,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>\n                    Patent foramen ovale (PFO) is a congenital cardiac defect present in approximately 30% of the general population. While often asymptomatic, it is associated with cryptogenic stroke and paradoxical embolism. Percutaneous closure using atrial septal defect occluder is an effective preventive strategy, but these devices carry a risk of rare complications, including infective endocarditis. Device-associated infective endocarditis is often linked to transient bacteremia following invasive procedures, highlighting the importance of antibiotic prophylaxis. However, the clinical presentation can be variable, requiring a high index of suspicion and advanced imaging for the diagnosis. We describe the case of a 55-year-old woman with hypertension, obesity, and a history of PFO closure with an Amplatzer occluder, who developed infective endocarditis weeks after a dental procedure. She presented with fever, vomiting, and confusion, initially misdiagnosed with encephalitis. Transesophageal echocardiography revealed large filamentous vegetation on the Amplatzer occluder, causing functional mitral regurgitation. Blood cultures identified\n                    <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">Streptococcus pneumoniae<\/jats:italic>\n                    , confirming a mixed bacterial infection. The patient underwent surgical removal of the infected device and mitral valve repair. Postoperatively, she improved significantly and was discharged with a complete course of antibiotics. This case underscores the need for vigilance in patients with intracardiac devices, particularly following bacteremia-inducing procedures. Early diagnosis using echocardiography and prompt surgical intervention are essential to managing device-related infective endocarditis. While antibiotic prophylaxis may reduce the risk of bacteremia-related infections, the lack of high-quality evidence necessitates further research to guide preventive strategies. Multidisciplinary care and strict adherence to diagnostic and therapeutic protocols remain pivotal to improving patient outcomes.\n                  <\/jats:p>","DOI":"10.4103\/jcecho.jcecho_11_25","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T08:00:19Z","timestamp":1753948819000},"page":"175-178","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The Pandora\u2019s Box of Cardiac Devices: A Case of Infective Endocarditis Postpatent Foramen Ovale Closure"],"prefix":"10.4103","volume":"35","author":[{"given":"Fulvio","family":"Cacciapuoti","sequence":"first","affiliation":[{"name":"Division of Cardiology, A. Cardarelli Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Minicucci","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Leonardo Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenno","family":"Fiorani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, G. Moscati Hospital, Avellino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Caso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, V. Monaldi Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mafalda","family":"Esposito","sequence":"additional","affiliation":[{"name":"Division of Cardiology, A. Cardarelli Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca Gaetano","family":"Tarquinio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Postgraduate School of Emergency Medicine, L. Vanvitelli University, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Mattiello","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Leonardo Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Di Pietro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Leonardo Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Leonardo Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Mauro","sequence":"additional","affiliation":[{"name":"Division of Cardiology, A. Cardarelli Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/ene.12673","article-title":"Cryptogenic stroke","volume":"22","author":"Fonseca","year":"2015","journal-title":"Eur J Neurol"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1161\/STROKEAHA.123.040546","article-title":"Patent foramen ovale management for secondary stroke prevention: State-of-the-art appraisal of current evidence","volume":"55","author":"Sposato","year":"2024","journal-title":"Stroke"},{"key":"R4-20260421","first-page":"324","article-title":"Infective endocarditis after device closure of atrial septal defects: Case report and review of the literature","volume":"89","author":"Amedro","year":"2017","journal-title":"Catheter Cardiovasc Interv"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1001\/jamacardio.2024.0873","article-title":"Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures: A systematic review and meta-analysis","volume":"9","author":"Sperotto","year":"2024","journal-title":"JAMA Cardiol"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.jcmg.2021.09.029","article-title":"Best practices for imaging cardiac device-related infections and endocarditis: A JACC: Cardiovascular imaging expert panel statement","volume":"15","author":"Dilsizian","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11883-015-0525-6","article-title":"PFO closure for cryptogenic stroke","volume":"17","author":"Gillow","year":"2015","journal-title":"Curr Atheroscler Rep"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"131","DOI":"10.52198\/23.STI.43.CV1740","article-title":"Infective endocarditis after percutaneous device closure of atrial septal defects: Incidence, diagnosis, and treatment. Case report and literature review","volume":"43","author":"Nasso","year":"2023","journal-title":"Surg Technol Int"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"899","DOI":"10.4067\/s0034-98872018000700899","article-title":"Antimicrobial prophylaxis for transient bacteremia during dental procedures","volume":"146","author":"Fern\u00e1ndez","year":"2018","journal-title":"Rev Med Chil"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"w20473","DOI":"10.4414\/smw.2021.20473","article-title":"Infective endocarditis: Prevention and antibiotic prophylaxis","volume":"151","author":"Sendi","year":"2021","journal-title":"Swiss Med Wkly"},{"key":"R11-20260421","doi-asserted-by":"crossref","first-page":"e239811","DOI":"10.1136\/bcr-2020-239811","article-title":"Unusual presentation of infective endocarditis in ICU","volume":"14","author":"Lincoln","year":"2021","journal-title":"BMJ Case Rep"},{"key":"R12-20260421","doi-asserted-by":"crossref","first-page":"659","DOI":"10.3390\/neurolint13040063","article-title":"Diagnostic yield of TEE in patients with cryptogenic stroke and TIA with normal TTE: A systematic review and meta-analysis","volume":"13","author":"Shah","year":"2021","journal-title":"Neurol Int"},{"key":"R13-20260421","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.jcin.2011.01.009","article-title":"Explantation of patent foramen ovale closure devices: A multicenter survey","volume":"4","author":"Verma","year":"2011","journal-title":"JACC Cardiovasc Interv"}],"container-title":["Journal of Cardiovascular Echography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_11_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:22:33Z","timestamp":1787836953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_11_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jcecho.jcecho_11_25","relation":{},"ISSN":["2211-4122","2347-193X"],"issn-type":[{"value":"2211-4122","type":"print"},{"value":"2347-193X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2025-02-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}