REPAIR OF FUNGAL AORTIC PROSTHETIC VALVE ENDOCARDITIS ASSOCIATED WITHPERIANNULAR ABSCESS

The incidence of prosthetic valve endocarditis is 2-4 %; in most cases the involved organisms are Staphylococcus epidermidis and Staph. aure us. Fungal endocarditis is much less common (incidence <0.1%), but it is often fatal, with a long-term mortality rate of 90-100%. Most funga l endocarditis cases occur after aortic valvular surgery, due to Candi da sp. Late-onset symptoms, long-term development and aggressive natur e of the fungus makes its eradication complicated and treatment diffic ult. Fungal valvular mycoses produce systemic embolization and cause s erious perioperative bleeding on resection of infected tissue. Usually surgery includes aortic root replacement with an aortic homograft con duit after radical debridement, to attain local sterilization. This re port describes a patient with complex infection, requiring replacement of an infected prosthetic valve with an aortic homograft conduit, agg ressive and radical debridement of infected tissue, and reconstruction using biologic tissues. The case demonstrates the importance of perio perative and long-term antifungal treatment and presents a modified 'C abrol procedure' to prevent critical intraoperative hemorrhage.