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Aspergillus aortitis after cardiac surgery.

Angel Sanchez-Recalde1, Isabel Maté, José L Merino

  • 1Unidad Médico-Quirúrgica de Cardiología, Hospital General Universitario La Paz, Madrid, Spain.

Journal of the American College of Cardiology
|February 7, 2003
PubMed
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Aspergillus aortitis, a rare infection after heart surgery, often leads to fatal multi-organ spread. Early consideration in patients with persistent fever and negative blood cultures is crucial for potential survival.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Medical Mycology

Background:

  • Aspergillus infection of the ascending aorta post-cardiopulmonary bypass is exceedingly rare.
  • Previous reports indicate a uniformly fatal outcome.

Purpose of the Study:

  • To delineate the clinical characteristics of Aspergillus aortitis.
  • To identify key diagnostic and prognostic factors in a series of patients.

Main Methods:

  • Retrospective analysis of eight male patients diagnosed with Aspergillus aortitis.
  • Confirmation via pathologic and microbiologic examination.
  • Review of clinical presentation, diagnostic imaging, and treatment outcomes.

Main Results:

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  • Patients underwent aortic valve replacement, coronary revascularization, or both.
  • Symptoms manifested from immediate post-op to two years later, often with prolonged fever.
  • Diagnosis was challenging, with only three ante-mortem confirmations using advanced imaging.
  • Seven of eight patients died, with one surviving after prompt surgical and antifungal treatment.
  • Pathology revealed multi-organ dissemination in most cases, with Aspergillus fumigatis identified.

    • Conclusions:

    • Aspergillus aortitis frequently occurs after aortic or coronary surgery.
    • Lethal multi-organ dissemination is common, typically sparing intracardiac structures.
    • Persistent fever and negative blood cultures post-cardiac surgery warrant consideration of this diagnosis.