Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction

Rizwan Q. Attia*, Justin L. Nowell, James Roxburgh

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    9 Citations (Scopus)

    Abstract

    A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity conditioning allogeneic haematopoietic cell transplantation. Subsequently, graft versus host disease required high-dose immunosuppressants. Computerized tomography on admission showed bilateral lung nodules and a suspicious cardiac mass. Bronchial biopsies demonstrated abundant hypae consistent with Aspergillus fumigatus infection. Echocardiography demonstrated a large fungus ball attached to the right coronary cusp of the aortic valve with near complete obliteration of the left ventricular outflow tract. Due to the high risk of embolization this was resected under cardiopulmonary bypass. The mass was attached subvalvularly to the ventricular septal free wall and eroding through it. It peeled off leaving intact aortic leaflets. Unresectable fungal deposits were discovered on the interventricular septum, the left ventricle free wall and posterior aortic wall. High-dose systemic antifungal therapy (Voriconazole and Amphoteracin B) was given for 4 months. After discharge she remained well till a 4-month follow-up, after which she eventually succumbed to her disease. We discuss the clinical difficulties in managing patients with fungal infective endocarditis and present a brief review of cardiac aspergillosis management.

    Original languageEnglish
    Pages (from-to)894-896
    Number of pages3
    JournalInteractive Cardiovascular & Thoracic Surgery
    Volume14
    Issue number6
    DOIs
    Publication statusPublished - Jun 2012

    Keywords

    • Aspergillosis
    • Infective endocarditis
    • Aortic valve
    • INVASIVE ASPERGILLOSIS
    • FUNGAL ENDOCARDITIS

    Fingerprint

    Dive into the research topics of 'Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction'. Together they form a unique fingerprint.

    Cite this