Successful Surgical Treatment for Fungal Endocarditis of the Ascending Aorta after Aortic Valve Replacement
10.4326/jjcvs.34.205
- VernacularTitle:大動脈弁置換術後の上行大動脈壁に発生した真菌性心内膜炎の１例
- Author:
Seiji Kinugasa
;
Fumitaka Isobe
;
Keiji Iwata
;
Yukiya Nomura
;
Motoko Saito
;
Nasatoshi Hata
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2005;34(3):205-208
- CountryJapan
- Language:Japanese
-
Abstract:
A 69-year-old woman underwent aortic valve replacement (AVR) for prosthetic valve (FreestyleTM 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.
