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[Two cases of Aspergillus endocarditis after cardiac surgery in childhood]
S Kawasaki1, Y Naitoh, Y Takagaki
1Department of Cardiovascular Surgery, Kita-Ishikai Hospital, Ohzu, Japan.
Insights
Aspergillus endocarditis is a severe complication after congenital cardiac surgery. Surgical intervention and graft replacement can effectively manage this challenging infection in pediatric patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Aspergillus endocarditis is a rare but life-threatening condition, particularly challenging to diagnose and treat.
- Congenital cardiac surgery presents a risk for developing fungal endocarditis, often involving prosthetic materials.
Observation:
- Two pediatric cases of Aspergillus endocarditis following congenital cardiac surgery are presented.
- Case 1: A 5-year-old boy developed pulmonary arterial patch infection post-atrial septal defect repair with a porcine-pericardial patch.
- Case 2: A 5-year-old girl experienced right ventricular outflow tract patch infection and mediastinitis after tetralogy of Fallot repair using an autologous pericardial patch.
Findings:
- Successful management involved pulmonary arterial reconstruction with an expanded polytetrafluoroethylene (E-PTFE) patch in Case 1.
- Case 2 required multiple patch revisions, ultimately treated with thorough debridement and an E-PTFE Y-graft bypass, resolving recurrent infection.
Implications:
- These cases highlight the potential for Aspergillus endocarditis in pediatric cardiac surgery patients.
- Aggressive surgical management, including patch material selection and reconstruction techniques, is crucial for favorable outcomes.
- Early diagnosis and prompt, tailored surgical intervention can prevent fatal outcomes in Aspergillus endocarditis.
Abstract:
Aspergillus endocarditis has been considered as a fatal disease because of the difficulty of diagnosis and treatment. Two cases of Aspergillus endocarditis after congenital cardiac surgery are reported. One case was 5-year-old boy after patch closure of atrial septal defect and enlargement of porcine-pericardial patch to pulmonary arterial stenosis. Pulmonary arterial patch infection with vegetation occurred 13 months after operation, and he underwent pulmonary arterial reconstruction with E-PTFE patch after complete removal of porcine-pericardial patch. The other case was 5 year-old girl after repair of tetralogy of Fallot with autologus pericardial monocusp patch. Right ventricular outflow patch infection and mediastinitis occurred 14 months after operation. Although three times of the patch exchange, patch infection relapsed. Therefore, she underwent thorough curettage of infected tissue, and extra-anatomical bypass to bilateral pulmonary artery from right ventricle with E-PTFE Y-graft. The relapse of endocarditis has not been recognized after these surgical treatments in both patients.