Aspergillus terreus infective endocarditis on a porcine heterograft valve

We present the first reported case of Aspergillus endocarditis occurring on a porcine heterograft prosthesis and discuss the literature regarding both Aspergillus endocarditis and endocarditis on a porcine valve. A 65-year-old man underwent aortic valve replacement with a porcine heterograft. Several weeks later he exhibited signs of infection and then of valve failure. Upon removal, the porcine valve substance was found to be grossly infiltrated and destroyed by the Aspergillus organism. The porcine valve has an excellent reputation of being resistant to infection and relatively easy to sterilize by medical management alone. Several surveys attest to the low incidence of endocarditis. Because of our experience with the destruction caused by Aspergillus, however, and because antimicrobials generally fail to eradicate this organism, we urge prompt operation to remove the heterograft valve involved with infection by this organism. The valve diseased with Aspergillus should be replaced with a mechanical prosthesis. In the aortic position, extra-anatomic replacement should be considered to facilitate eradication of periannular infection postoperatively.