Aspergillus flavus endaortitis following aortic valvotomy

Abstract

Aspergillar endaortitis does not seem to have been described before in the English literature. Our patient had undergone aortic valvotomy and subsequently developed leg pains, migratory arthralgias, periarticular swelling, and general malaise. Mild Pope, and Friedman, 1963 ;Newman and Cordell, 1964;Climie and Rachmaninoff, 1965;Lerner and Weinstein, 1966;McConnell and Roberts, 1967). Candida is the organism most commonly responsible but aspergillus endocarditis has been reported following Starr-Edwards mitral valve replacement (Newman and Cordell, 1964) and fascia lata aortic cusp advancement (Clinicopathological Conference, 1969; News and Notes, British Medical Journal, 1970). The much rarer, but nevertheless analogous, entity of aspergillus endaortitis appears to have been described but once and that by Hadorn (1960) At operation an angiographically demonstrable gross dilatation of the ascending aorta was confirmed and there was some calcification of the aortic valve cusps. His post-valvotomy cardiovascular status was excellent with a blood pressure of 115/85 mmHg and no auscultatory evidence of aortic incompetence.He remained well until four months before admission when an infection of carpentry cuts on the hands progressed to local cellulitis, which was successfully treated by oral penicillin for three days. One month later he had sudden right calf and right foot pain, with a cool, pale right foot. The pain lasted four days, and three more similar episodes followed in both legs. Two months before admission migratory severe arthralgias, periarticular swelling, and tenderness affected several joints including the ankles, knees, hips, and wrists. The symptoms lasted a few days and sometimes were sufficiently incapacitating to make walking difficult, though phenylbutazone was of some benefit. Thereafter nailfold splinter haemorrhages were seen and a few painful fingertip nodules healed without scarring. Slight anorexia supervened a week before he entered hospital.Clinically the patient looked fit and was afebrile, with poor dentition and a few small, mobile, tender nodes palpable in the left axilla. The hands were unremarkable. The pulse was normal and regular and the blood pressure 120/90 mmHg. He had no ventricular hypertrophy or failure and auscultation revealed normal first and second heart sounds with a grade 2/6 aortic ejection systolic murmur which had not altered during his eight-month postoperative follow-up. No pulses were palpable in the ankles or 435 on 28 April 2019 by guest. Protected by copyright.

Post-operative aspergillosis

“…summarises some clinical details for 124 patients with Aspergillus endocarditis or aortitis following heart surgery [4,8–91]. The median age of these patients was 43.5 (range 0.8–71) years.…”

Aortic lesions in aspergillosis: histopathological study of two autopsy cases

“…In contrast, the elastic fibers of the media were well preserved. These different histopathological features in the three layers of the aorta seem to represent one of the typical tissue reaction patterns of the aortic wall in aspergillus infection, although other reaction patterns such as granuloma formation in the media [11] have also been reported.…”

“…They include the formation of a mural thrombus [8], embolic occlusion of the aortic lumen [2,10], aortic aspergilloma [15], mycotic aneurysm [4,11,12] or pseudoaneurysm [3], rupture of the sinus of Valsalva [7], and aspergillus aortitis [6,11,15]. These aortic lesions have been discussed with particular reference to their clinical and hemodynamic aspects, but there are very few detailed descriptions and analysis of histopathological findings.…”

Aspergillus clavatus Endocarditis Involving a Normal Aortic Valve Following Coronary Artery Surgery

“…Fungal aortitis has been reported in eight patients following cardiac surgery [11,12,13]. These infections generally occur along suture lines at aortotomy sites.…”