Document Detail


Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction.
MedLine Citation:
PMID:  22374293     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Rizwan Q Attia; Justin L Nowell; James C Roxburgh
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Publication Detail:
Type:  Case Reports; Journal Article; Review; Video-Audio Media     Date:  2012-02-27
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  14     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-09-07     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  894-6     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK. rizwan.attia@kcl.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Antifungal Agents / therapeutic use
Aspergillosis / diagnosis,  microbiology*,  therapy
Aspergillus fumigatus / isolation & purification*
Cardiac Surgical Procedures
Echocardiography
Endocarditis / diagnosis,  microbiology*,  therapy
Fatal Outcome
Female
Hematopoietic Stem Cell Transplantation / adverse effects
Humans
Immunosuppressive Agents / adverse effects
Leukemia, Lymphocytic, Chronic, B-Cell / surgery
Middle Aged
Tomography, X-Ray Computed
Treatment Outcome
Ventricular Outflow Obstruction / diagnosis,  microbiology*,  therapy
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Immunosuppressive Agents
Comments/Corrections

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