Repair of fungal aortic prosthetic valve endocarditis associated with periannular abscess

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Published on: December 11, 2017

E S Remsey1, B W Lytle

  • 1State University of New York, Health Science Center at Brooklyn, New York, USA.

The Journal of Heart Valve Disease
|May 20, 1998
PubMed

Insights

Fungal endocarditis, though rare, has a high mortality rate. This case highlights successful surgical and antifungal treatment for a complex fungal prosthetic valve infection.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Innovation

Background:

  • Prosthetic valve endocarditis (PVE) affects 2-4% of patients, typically caused by Staphylococcus species.
  • Fungal endocarditis (FE) is rare (<0.1%) but carries a grim prognosis with 90-100% long-term mortality.
  • Candida species are the most common culprits in FE, often occurring post-aortic valve surgery.

Observation:

  • Fungal valvular mycoses present diagnostic and therapeutic challenges due to late onset, aggressive fungal nature, systemic embolization, and severe bleeding risks.
  • This case involved a complex prosthetic valve infection requiring extensive surgical intervention.
  • The patient underwent prosthetic valve replacement with an aortic homograft conduit, radical debridement, and reconstruction with biologic tissues.

Findings:

  • The successful management involved a modified 'Cabrol procedure' to control intraoperative hemorrhage.
  • Aggressive surgical debridement and reconstruction were crucial for local sterilization.
  • Perioperative and long-term antifungal therapy were essential components of the treatment strategy.

Implications:

  • This case underscores the critical role of comprehensive antifungal treatment in managing fungal prosthetic valve endocarditis.
  • Surgical techniques like the modified 'Cabrol procedure' can be vital for managing bleeding complications.
  • Effective treatment necessitates a multidisciplinary approach combining surgical expertise and prolonged antifungal therapy.

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