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AngioVac-assisted management of histoplasma capsulatum endocarditis in a bioprosthetic aortic valve: challenges and

Qutaiba Qafisheh1, Abdalhakim Shubietah2, Roaa Aljunaidi3

  • 1Department of Internal Medicine, University of Toledo, Toledo, USA.

Journal of Cardiothoracic Surgery
|April 18, 2025
PubMed
Abstract

Insights

Histoplasma capsulatum infective endocarditis (IE) is rare. AngioVac aided in managing large fungal vegetations in a prosthetic valve patient, highlighting the need for considering fungal IE in culture-negative cases.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Medical Device Technology

Background:

  • Histoplasma capsulatum infective endocarditis (IE) is a rare but often fatal condition.
  • Prosthetic valve patients are at high risk due to diagnostic delays and limited treatment options.
  • Fungal IE should be considered in culture-negative cases, particularly in high-risk individuals.

Purpose of the Study:

  • To report a case of Histoplasma capsulatum infective endocarditis in a prosthetic valve patient.
  • To demonstrate the utility of the AngioVac system for managing large fungal vegetations.
  • To emphasize the importance of a multidisciplinary approach in managing complex IE cases.

Main Methods:

  • A 76-year-old female with a bioprosthetic aortic valve presented with persistent culture-negative fever and splenic infarcts.
  • AngioVac-assisted debulking was performed for large vegetations on the prosthetic valve.
  • Tissue cultures obtained during debulking confirmed Histoplasma capsulatum.

Main Results:

  • AngioVac facilitated the removal of large fungal vegetations, enabling diagnosis of Histoplasma capsulatum.
  • Despite prompt antifungal therapy and multidisciplinary management, the patient experienced recurrent embolic events and septic shock.
  • The patient ultimately succumbed to the infection.

Conclusions:

  • This case highlights the critical need to consider fungal IE in culture-negative endocarditis, especially in patients with prosthetic valves.
  • Advanced diagnostic tools and minimally invasive interventions like AngioVac can play a role in managing complex fungal IE.
  • Despite interventions, the management of severe fungal IE remains challenging, underscoring the need for early diagnosis and comprehensive care.
Keywords:
AngioVacAortic valve endocarditisCase reportFungemiaHistoplasma endocarditisVegetation

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