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A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium

BACKGROUND: Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relap...

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Autores principales: de Santis, Antonio, Gilberto, Guilherme Moratti, Mangini, Sandrigo, Megale, Adalberto Batalha, Gaiotto, Fabio Antonio, Terra, Ricardo Mingarini, Garcia, Rodrigo Gobbo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603709/
https://www.ncbi.nlm.nih.gov/pubmed/33129270
http://dx.doi.org/10.1186/s12872-020-01755-z
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author de Santis, Antonio
Gilberto, Guilherme Moratti
Mangini, Sandrigo
Megale, Adalberto Batalha
Gaiotto, Fabio Antonio
Terra, Ricardo Mingarini
Garcia, Rodrigo Gobbo
author_facet de Santis, Antonio
Gilberto, Guilherme Moratti
Mangini, Sandrigo
Megale, Adalberto Batalha
Gaiotto, Fabio Antonio
Terra, Ricardo Mingarini
Garcia, Rodrigo Gobbo
author_sort de Santis, Antonio
collection PubMed
description BACKGROUND: Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. CASE PRESENTATION: We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. CONCLUSIONS: Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.
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spelling pubmed-76037092020-11-02 A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium de Santis, Antonio Gilberto, Guilherme Moratti Mangini, Sandrigo Megale, Adalberto Batalha Gaiotto, Fabio Antonio Terra, Ricardo Mingarini Garcia, Rodrigo Gobbo BMC Cardiovasc Disord Case Report BACKGROUND: Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. CASE PRESENTATION: We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. CONCLUSIONS: Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication. BioMed Central 2020-10-31 /pmc/articles/PMC7603709/ /pubmed/33129270 http://dx.doi.org/10.1186/s12872-020-01755-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
de Santis, Antonio
Gilberto, Guilherme Moratti
Mangini, Sandrigo
Megale, Adalberto Batalha
Gaiotto, Fabio Antonio
Terra, Ricardo Mingarini
Garcia, Rodrigo Gobbo
A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title_full A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title_fullStr A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title_full_unstemmed A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title_short A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
title_sort medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603709/
https://www.ncbi.nlm.nih.gov/pubmed/33129270
http://dx.doi.org/10.1186/s12872-020-01755-z
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