title: Recalcitrant prosthetic valve endocarditis requiring repeated reconstruction: running out of options.
abstract: In this report we describe a previously healthy 36-year-old man who presented with septic shock secondary to bacterial endocarditis with multiple cerebral, mesenteric, and peripheral embolic phenomena. He underwent emergent porcine prosthetic valve replacement with aortic annular reconstruction. Subsequently, he developed recalcitrant Candida parapsilosis endocarditis requiring treatment with multiple antifungal agents and 4 repeated complex reconstructions of the aortic root and fibrous trigones over 3 years, before the infection was successfully controlled. This case underscores the significant morbidity associated with fungal endocarditis and importance of an early combined medical and surgical approach.
authors.affiliation: Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Pepe
authors.affiliation: Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Microbiology and Immunology, Schulich School of Medicine, Western University, London, Ontario, Canada.
authors.forename: Ram V
authors.initials: RV
authors.lastname: Anantha
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Currie
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.
authors.forename: John K
authors.initials: JK
authors.lastname: McCormick
authors.affiliation: Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Microbiology and Immunology, Schulich School of Medicine, Western University, London, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
authors.forename: Tina
authors.initials: T
authors.lastname: Mele
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada. Electronic address: Michael.chu@lhsc.on.ca.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed