| Successful Surgical Treatment for Fungal
Endocarditis of the Ascending Aorta after Aortic Valve Replacement |
(Department of Cardiovascular Surgery,
Osaka National Hospital, Osaka, Japan)
| Seiji Kinugasa |
Fumitaka Isobe |
Keiji Iwata |
| Yukiya Nomura |
Motoko Saito |
Masatoshi Hata |
|
A 69-year-old woman underwent aortic
valve replacement (AVR) for prosthetic valve (Freestyle™ stentless
valve) endocarditis (PVE) in April 2001. The patient was admitted
to our hospital with diarrhea and tarry stools in January 2002 and
was treated with intravenous hyperalimentation. She had fever and
inflammatory findings at 1 week after admission, and was given
intravenous antibiotics. Symptoms and laboratory findings improved
gradually, but transesophageal echocardiography revealed a mobile
mass in the ascending aorta near the noncoronary sinus of Valsalva.
The serum β-D glucan level was elevated and blood culture was positive
for Candida parapsilosis. These findings suggested fungal endocarditis
of the ascending aorta, so the patient underwent surgery. Vegetation
was attached to the aortic wall near the noncoronary sinus of Valsalva.
It was removed with part of the ascending aorta, followed by reconstruction
with a gusset xenograft. In addition, aortic valve replacement was performed
with a mechanical valve. The resected tissue grew C. parapsilosis,
so parenteral anti-fungal drugs were administered intravenously for 8 weeks
after surgery. Although cerebral infarction occurred, she was discharged
on the 133rd postoperative day. There was no recurrence of infection and
she remained on oral anti-fungal medication for 24 months postoperatively.
Jpn. J. Cardiovasc. Surg. 34: 205-208 (2005) |
|
