Fungal Ball Blocking the Aortic Valve

Abstract

An 18-year-old male had undergone aortic valve replacement (Starr Edward 23mm) for severe aortic regurgitation secondary to bicuspid aortic valve with left ventricular dysfunction (ejection fraction 35%) in a state hospital eight months ago. Four weeks after the surgery, he had developed prosthetic valve endocarditis with multiple aortic root abscesses and vegetations for which replacement of the prosthetic valve with homograft aortic valve was done. Culture had grown aspergillus niger from the vegetations and he was treated with intravenous amphotericin B and oral fluconazole. Three months after the discharge, he presented to our center with pain in right iliac fossa and both the lower limbs. Doppler examination of both the lower limb arteries revealed bilateral blocked dorsalis pedis arteries. An echocardiogram revealed a large ball of vegetation almost blocking the aortic valve (Figs. 1A and B).