Intravenous sildenafil in right ventricular dysfunction with pulmonary hypertension following a heart transplant.

The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant (HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented. The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg. In all cases, the hemodynamic study demonstrated PH reactivity (positive vasodilator test with nitric oxide). All 5 patients developed RVD with hemodynamic instability immediately after the HT, despite the administration of nitric oxide from the time of intubation prior to the implant, optimal medical treatment in all cases, and a ventricular assist in 2 cases. In all patients, IV sildenafil was initiated at 10 mg/8 h for 48 h and was subsequently increased to 20 mg/8 h. in its oral formulation until discharge from the hospital. The change in pulmonary pressure was assessed using a Swan-Ganz catheter. Ventricular function was assessed using echocardiography. Length of stay in the Resuscitation Unit and mid-term survival were also assessed. Average time of extracorporeal circulation was 200 ± 110 min and organ ischemic time was 210 ± 95 min. All of the patients demonstrated pulmonary and systemic hemodynamic improvement, as well as recovery of right ventricular function after completing the treatment with IV sildenafil. The stay in the Resuscitation Unit lasted 3-25 days. All the patients were discharged from hospital with no mortality to date. Intravenous sildenafil improves right ventricle hemodynamics associated with pulmonary hypertension post-HT. Prophylactic prevention with this drug could be indicated for patients with reactive PH who are about to receive a transplant.

[Native valve Aspergillus fumigatus endocarditis with blood culture positive and negative for galactomannan antigen. Case report and literature review]. / Endocarditis por Aspergillus fumigatus en válvula nativa con hemocultivo positivo y galactomanano negativo. Descripción de un caso y revisión de la literatura.

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.

Endocarditis por Aspergillus fumigatus en válvula nativa con hemocultivo positivo y galactomanano negativo. Descripción de un caso y revisión de la literatura / Native valve Aspergillus fumigatus endocarditis with blood culture positive and negative for galactomannan antigen. Case report and literature review

La endocarditis infecciosa causada por Aspergillus es infrecuente y sepresenta en pacientes con cirugía cardiaca previa o en inmunodeficientes.Por lo general, el aislamiento del moho se realiza post-mortem, si bien elcultivo de la válvula o, en muy pocos casos, el hemocultivo permiten suaislamiento. Describimos un caso de endocarditis infecciosa por Aspergillusfumigatus sobre válvula nativa mitral, con aislamiento de Aspergillus en lavegetación valvular y en el hemocultivo. A pesar del recambio valvular y derecibir una terapia combinada con voriconazol y caspofungina, el pacientefalleció con aspergilosis diseminada confirmada en la necropsia. El presentesería el tercer caso descrito de endocarditis infecciosa por Aspergillus conhemocultivo positivo. Paradójicamente, la determinación del antígeno degalactomanano fue negativa(AU)

Native valve endocarditis caused by Aspergillus spp. is an uncommon diseasewith a high mortality rate. Generally, Aspergillus is isolated from affected valvein post-mortem or biopsy specimens. However, its isolation from bloodcultures is exceedingly rare. We report a case of fungal endocarditis in anative mitral valve with the isolation of Aspergillus fumigatus both in valvevegetation and in blood culture bottles. The patient underwent valvereplacement and antifungal treatment with voriconazole and caspofungin, buthe died on post-operative day 45 with disseminated aspergillosis confirmed bynecropsy. Paradoxically, galactomannan antigen detection in serum wasnegative. This is the third case of Aspergillus endocarditis with positive bloodculture reported in the literature(AU)