Patient: Male, 36Final Diagnosis: Aspergillus flavus endocarditisSymptoms: Malaise • fatigue and dyspneaMedication: —Clinical Procedure: Mitral vale replacemnetSpecialty: CardiologyObjective:Rare diseaseBackground:Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection.Case Report:We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome.Conclusions:Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment.
All patients undergoing cardiac surgery suffer deterioration in pulmonary functions. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions. Moreover, preserving pleural integrity provides beneficial effects on pain score after coronary operations especially in the early postoperative period.
SUMMARYWe report a single center experience of surgical treatment of 30 cases of left-sided prosthetic valve thrombosis (PVT). In our series, a diagnosis of PVT was established based on clinical and echocardiographic examinations. Thrombosis was the major etiologic factor in 25 patients (83.3%), while 22 of 25 patients (88%) had a subtherapeutic anticoagulation level. The early hospital mortality rate was 7.1% in patients with New York Heart Association (NYHA) functional classes II -III, and 31.3% in NYHA functional class IV. The median interval from the surgical procedure to follow-up for these patients was 29. Prosthetic valve thrombosis (PVT) is a rare but life-threatening condition. The incidence of PVT ranges from 0.03 to 4.3% patient-years, depending on the generation and the biocompabilities of the prosthesis used, the location of the valve, and inadequate or discontinued anticoagulation therapy.1, 2) Surgical mortality increases from 2% to 4% in low-risk groups to 37% to 54% in high-risk groups. [3][4][5] We report a single center experience of surgical treatment of 30 cases of leftsided PVT in order to better analyze the factors influencing success, determining operative mortality, and long-term survival.From the
Tangential suture technique allows the needle to take a longer segment from the media layer while decreasing the likelihood of entering the lumen. Because the tract of the suture almost perfectly fits to the needle curve, tissue injury is less, even on fragile aortas, and this ensures more stable closure of the hole when the suture is tied following decannulation. By considering both its theoretical advantages and our clinical experience, we believe tangential suture technique should be preferred to the classic method.
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