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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Recurrent Prosthetic Aortic Valve Aspergillus Endocarditis Requiring Fourth Redo Root Surgery
Krista Kaufmann1, Tess Calcagno1, Shinya Unai2
1Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Fungal prosthetic valve endocarditis is rare, frequently culture-negative, and often complicated by embolization, making diagnosis challenging.
Case Summary:
A 58-year-old man with prior bioprosthetic aortic valve surgery presented with splenic infarction and prosthetic valve dysfunction. Transesophageal echocardiography demonstrated an immobile echodensity encasing the valve, with elevated gradients. Blood cultures and serologic testing were repeatedly negative, and he was initially treated for presumed valve thrombosis. Despite therapeutic anticoagulation, he developed recurrent fevers and popliteal artery emboli, prompting urgent surgery. Operative findings revealed friable vegetations and a shallow aortic root abscess. Histopathology demonstrated fungal elements, and MALDI-TOF mass spectrometry identified a cryptic species within the Aspergillus fumigatus section, Aspergillus (Neosartorya) hiratsukae, with sexual reproductive structures.
Discussion:
The case highlights the limitations of conventional diagnostics and the value of advanced microbiologic identification.
Take-Home Message:
Culture-negative prosthetic valve dysfunction with embolization should prompt suspicion for fungal endocarditis and early surgical consideration.
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