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European Heart Journal Advance Access originally published online on August 3, 2006
European Heart Journal 2007 28(2):153; doi:10.1093/eurheartj/ehl178
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Contained aortic rupture secondary to post-surgery mediastinitis due to Aspergillus fumigatus

Jaime Nevado Portero1,*, Mariano Ruíz Borrell2 and Lourdes Gómez Izquierdo3

1 Department of Cardiology, Virgen del Rocío University Hospital, Av. Manuel Siurot s.n., Seville 41013, Spain
2 Department of Cardiology, San Juan de Dios del Aljarafe Hospital, Av. San Juan de Dios s.n., Bormujos 41930 (Seville), Spain
3 Department of Pathological Anatomy, Virgen del Rocío University Hospital, Av. Manuel Siurot s.n., Seville 41013, Spain

* Corresponding author: Tel: +34 653830847; fax: +34 954272333. E-mail address: jaimenevado{at}hotmail.com

Male, aged 74, with chronic respiratory disease and degenerative aortic stenosis, operated 45 days ago to replace the valve with a biological prosthetic valve. The patient came for a consultation due to class III dyspnoea and long-term oppressive retrosternal pain. Transthoracic echocardiography was carried out showing normal prosthetic functioning, good contractility in all segments, and collapsed right atrium due to severe pericardic haematoma (Panel A). The transoesophagic echocardiography showed the haematoma from the aortic root, spreading upwards across the whole of the mediastinum (Panel B). Intimal flap, double lumen, or bleeding was not seen. Given these findings, it was decided to carry out a thoracic CAT, which gave pictures of a large-scale haematic collection displacing the mediastinal structures to the left. Its density is heterogeneous suggesting an acute extravasation originating at the level of the aortic root (Panel C).

In light of these findings, it was decided to carry out emergency surgery. After sternotomy, intense haemorrhage resulted, which could not be controlled, eventually causing exitus due to haemorrhagic shock. The proximal ascending aorta was damaged and the tissues presented signs of infection. Samples were sent for histopathological examination. The Gomori-Grocott stain revealed the invasion of Aspergillus fumigatus in the external third of the aortic wall (Panel D).

Mediastinitis, post-heart surgery, due to Aspergillus fumigatus, is extremely rare. Unfavourable prognosis presented due to the potential complications and given that the case developed sporadically and it was ensured that the hospital atmosphere was optimal; it was postulated that the aetiology of the picture was the passage of the micro-organism to the mediastinum by pleural incision in the patient with chronic respiratory disease and colonized pulmonary parenchyma.

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This Article
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28/2/153    most recent
ehl178v1
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Right arrow Articles by Nevado Portero, J.
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