Fungal Endocarditis After Hybrid Periventricular Closure of Muscular Ventricular Septal Defect by Amplatzer Occluder in a Child

A 2-year-old boy was admitted for a 16-day history of intermittent fever (up to 40.5°C) with no other symptom. He had been followed since birth for a large midmuscular ventricular septal defect with a left-to-right shunt and signs of congestive heart failure. At 2 months of age, the patient had a pulmonary artery banding, and at 16 months of age he underwent hybrid periventricular closure of a muscular ventricular septal defect by Amplatzer occluder and removal of the pulmonary band.A 12-mm Amplatzer muscular ventricular septal defect (VSD) occluder was implanted through a direct puncture of the right ventricular free wall. Postoperative echocardiography initially showed a 7-mm residual muscular VSD at the inferior border of the device with a moderate left-to-right shunt that progressively decreased to a 3- to 4-mm residual VSD over the next few months. During postoperative follow-up, the patient’s condition improved with decreasing heart failure signs. Treatment with diuretics and angiotensin-converting enzyme inhibitor, and aspirin as well, was continued. Over the next 8 months he received several courses of antibiotics for various infections.On admission, the patient was subfebrile (37.7°C). His heart rate was 144 bpm, blood pressure was 121/75 mm Hg. Chest examination revealed a holosystolic …