Seven of eight patients survived Aspergillus endocarditis when heart valve surgery was performed (valve replacement, resection of vegetations) while only 1/17 survived with conservative treatment alone. Interestingly, 74% of the patients included in this analysis had a history of recent surgery, 68% of which had heart surgery performed, suggesting recent heart surgery as a risk factor for Aspergillus contamination of the endocardium during surgery. LY2606368 mw Aspergillus pericarditis is rare and usually develops
from adjacent infected tissue, such as an expanding pulmonic Aspergillus focus, from spreading Aspergillus myocarditis or by surgical contamination. As published in a review evaluating 29 cases, Aspergillus infection of the pericardium was always the result of contiguous dissemination of the lung or myocardium.
In that review only four of the 29 reported patients survived the infection. Diagnosis VX-770 in vivo of Aspergillus pericarditis is challenging, which may be a reason for frequently delayed decision for surgery. Electrocardiogram and echocardiography are the investigations of choice. They may show signs of pericardial effusion or thickening of the pericardium. However, these investigations may also appear normal. Only in 10 of the 29 cases, the pericarditis was correctly diagnosed before death and in all of these 10 cases Aspergillus infection affecting other organs had already been diagnosed before. Rapid pericardiectomy and/or surgical drainage under systemic antifungal therapy is recommended to prevent cardiac-related death and to gain tissue for diagnostics. Pericardial tamponade, haemodynamic deterioration and cardiac arrest Thymidine kinase due to arrhythmia[66-68] contribute to the reported fatal outcome. In a study published in 2000 by Silva et al. , eight cases of culture proven Aspergillus infection of an aortic aneurysm – all without prior surgery – were
investigated. All eight patients received surgical intervention; however, only three patients survived. Interestingly the three patients, who survived received all a resection of the aneurysm with in situ graft replacement, whereas the five patients who died, only had smaller surgery like embolectomy, indicating that resection of the mycotic aneurysm is crucial for outcome. In most patients of that study, the suspected primary focus of Aspergillus infection was the lung, spreading via vascular invasion. Primary Aspergillus infection of the lung can lead to erosion of the tissue and building of aortobronchial fistula, presenting clinically with haemoptysis. In these cases, partial pneumectomy and resection of the affected vessels are necessary.[69, 70] Aspergillus aneurysms of the aorta have also been reported to be caused by prior surgical interventions, either during cardiac valve replacement or grafting of aortic dissection, resulting in major complication and life-threatening embolic events.