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

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