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Homograft replacement of fungal endocarditic pulmonary valve
M Tolan1, S Clarke, P Schofield
1Department of Cardiac Surgery, Papworth Hospital, Cambridge, UK.
Abstract:
Right-sided infective endocarditis is uncommon but is increasingly seen as a reflection of the prevalence of drug abuse, chronic intravenous catheters and associated congenital malformations. Isolated pulmonary valve endocarditis has rarely been reported and there has been only one previous report of isolated pulmonary valve fungal endocarditis. This resolved with antimicrobials. We describe a case of isolated mycotic pulmonary valve endocarditis resistant to existing anti-fungal chemotherapy, which necessitated pulmonary valve resection and replacement with a homograft.
Insights
Right-sided infective endocarditis, particularly fungal, is rare. This case involved a patient with isolated pulmonary valve fungal endocarditis resistant to antifungal drugs, requiring surgical intervention.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Right-sided infective endocarditis is uncommon but rising, linked to drug abuse, IV catheters, and congenital heart defects.
- Isolated pulmonary valve endocarditis is exceptionally rare, with only one prior report of fungal involvement.
- Fungal endocarditis typically requires aggressive management beyond standard antimicrobial therapy.
Observation:
- A case of isolated mycotic (fungal) endocarditis specifically affecting the pulmonary valve is presented.
- The patient's infection proved resistant to standard antifungal chemotherapy regimens.
- This resistance necessitated a significant surgical intervention.
Findings:
- The mycotic pulmonary valve endocarditis did not resolve with empirical or targeted antifungal treatments.
- Surgical resection of the infected pulmonary valve was required for disease control.
- A pulmonary valve homograft was successfully implanted to replace the resected valve.
Implications:
- This case underscores the potential for rare fungal endocarditis to exhibit resistance to conventional antifungal agents.
- It highlights the critical role of surgical management in refractory cases of pulmonary valve endocarditis.
- The findings emphasize the need for vigilance and potentially alternative treatment strategies for challenging fungal infections of the heart valves.