Devastating fungal endocarditis involving ascending aorta in a patient with a history of aortic valve replacement: a case report.

BACKGROUND: Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures. CASE PRESENTATION: This report details a case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery. CONCLUSION: A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.

Congenital tunnel-shaped ventricular septal defect.

We report a 47-year-old man who presented with right-sided heart failure. Transthoracic echocardiography revealed a tunnel-shaped communication (ventricular septal defect) between the left ventricle and the right ventricle with a significant left-to-right shunt. The VSD is connected to the lateral wall of the right ventricle by a large tunnel.

Extensive right-sided endocarditis in double-chamber right ventricle presented with leukocytoclastic vasculitis.

Congenital heart disease is a risk factor for infective endocarditis (IE). Ventricular septal defects and ventricular outflow tract obstructions are this population's most common causes of endocarditis. We present a patient diagnosed with leukocytoclastic vasculitis, renal, and pulmonary involvement with right-sided IE as an etiology for vasculitis.

Re-emphasis on the role of echocardiography in diagnosis of aortic root surgery complications.

BACKGROUND: Aortic pseudoaneurysm is an infrequent complication of ascending aorta surgery. CASES: This is a report of two cases that underwent the Bentall procedure that presented with large pseudoaneurysms. CONCLUSION: Use of multimodality imaging after Bentall surgery has been advocated for the detection of surgical complications. Although 3D CT angiography has the highest diagnostic accuracy, familiarity with transthoracic echocardiographic finding in these patients will lead to earlier diagnosis.