Prosthetic valve endocarditis manifesting multiple huge aspergilloma / 대한내과학회지

ABSTRACT

Fungal prosthetic valve endocarditis is a rare, poo-prognostic disease. The risk factors for fungal valve endocardits are open heart surgery, hyperalimentation, antibiotic therapy, IV drug abuse, concomitant bacterial endocarditis and immunosuppression. We report a case of aspergillus endocarditis in the aortic valve, which extended to ascending aorta after Redo-aortic valve replacement surgery. A 22-year-old male patient underwent Redo-aortic valve replacement surgery with 23mm-sized Sorin valve(bi-leaflet tilting disc valve) due to prosthetic valve failure. He was readmitted because of development of cough, anorexia, fatigue and fever after operation. The results of repeated blood culture were negative, and the symptoms continued in spite of 2 week treatment with broad spectrum antibiotics. Echocardiography and spiral computed tomographic angiography revealed multiple, huge masses in the aortic valve extending to ascending aorta. Emergent surgery was performed. Infected valve and surrounding areas were widely excised and aortic homograft was inserted. Resected aorta and prosthetic valve showed multiple mass-forming vegetations, measuring up to 4cmx3cmx3cm. Microscopically, they revealed fungal organisms, showing sharp-angle branching and septate hyphae. Aspergillus flavus was isolated in culture of resected tissue. The patient suddenly died of ventricular fibrillation 3 weeks after surgery in spite of treatement with intravenous amphotericin B.