Repair of fungal aortic prosthetic valve endocarditis associated with periannular abscess

The incidence of prosthetic valve endocarditis is 2-4 %; in most cases the involved organisms are Staphylococcus epidermidis and Staph. aureus. Fungal endocarditis is much less common (incidence <0.1%), but it is often fatal, with a long-term mortality rate of 90-100%. Most fungal endocarditis cases occur after aortic valvular surgery, due to Candida sp. Late-onset symptoms, long-term development and aggressive nature of the fungus makes its eradication complicated and treatment difficult. Fungal valvular mycoses produce systemic embolization and cause serious perioperative bleeding on resection of infected tissue. Usually surgery includes aortic root replacement with an aortic homograft conduit after radical debridement, to attain local sterilization. This report describes a patient with complex infection, requiring replacement of an infected prosthetic valve with an aortic homograft conduit, aggressive and radical debridement of infected tissue, and reconstruction using biologic tissues. The case demonstrates the importance of perioperative and long-term antifungal treatment and presents a modified 'Cabrol procedure' to prevent critical intraoperative hemorrhage.