title: Systemic aspergilloma post aortic root surgery following coronary artery stenting: diagnostic and management dilemma.
abstract: Aspergillus infections such as Aspergillus endocarditis were once relatively rare occurrences, however, due to the increased use of intracardiac devices, the incidence has grown. With mortality rates close to 100%, in medically treated cases, it is paramount that early diagnosis and treatment are performed. An immunocompetent aviculturist presented 8 months post aortic root replacement for severe aortic regurgitation with a composite graft, with central crushing chest pain. Investigations confirmed ST elevation inferior myocardial infarction due to stenosis of the origin of the right coronary artery, which was stented. Echocardiogram demonstrated a mobile mass posterior to the left ventricular outflow tract. Following referral to our cardiothoracic surgeons, a polypoidal mass covering the right ostial button was noted along with systemic complications of the disease. Emergency redo aortic valve replacement with a homograft and coronary artery bypass was performed. Histological analysis confirmed A. fumigatus and the patient was started on intravenous voriconazole.
authors.affiliation: University Hospital of Leicester, Leicester, UK.
authors.forename: Nabil
authors.initials: N
authors.lastname: Hussein
authors.affiliation: Medical School, Keele University, Stoke on Trent, UK.
authors.forename: Sombul
authors.initials: S
authors.lastname: Qamar
authors.affiliation: Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK.
authors.forename: Qamar
authors.initials: Q
authors.lastname: Abid
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D002637:Chest Pain / Q000209:etiology; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D065819:Voriconazole / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole