Search

Abstract Background Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures. Case presentation This report details a case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery. Conclusion A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.

The aberrant subclavian artery is an uncommon congenital anomaly in the aortic arch, which may have a variety of presentations, including dysphagia, dyspnea, and chest pain, depending on the anatomical site of the aberrant vessel. Treatment is individualized, and surgical management is only considered in symptomatic patients. Dysphagia is one of the most important symptoms for which clinicians should consider surgery. Here, we present an interesting case of a 49-year-old woman who first came with the presentation of acute coronary syndrome and underwent coronary angiography, which showed no sign of significant lesions but revealed a probable abnormal left subclavian artery and right aortic arch. The patient refused further evaluation at that time; however, she came back after three years with progressive chest pain and dysphagia as a new complaint. After a step-by-step work-up for the patient's dysphagia, including barium swallow and upper endoscopy, chest CT angiography was performed that demonstrated a left aberrant subclavian artery as the potential cause of her complaints. After the diagnosis became clear, surgical ligation of the aberrant left subclavian artery and release of the vascular ring around the esophagus were done for the patient, as well as anastomosis of the left carotid artery to the left subclavian artery by saphenous vein graft interposition.