Rare large fungal ball extracted from elderly patient's aortic heart valve

By Shalini Bhardwaj
New Delhi [India], August 10 : The doctors at a private hospital in the national capital successfully treated a 70-year-old male patient, with fungal endocarditis, a rare condition in which fungus had developed in the heart's aortic valve, said the hospital officials said on Tuesday.
The team of doctors, led by Dr Udgeath Dhir, Director and Head of Cardiothoracic and Vascular Surgery (CTVS), Fortis Hospital, managed the case and through a complex surgery, successfully extracted the 6 cm-long fungal ball from the patient's heart valve.

This is a very rare case, sometimes found in cardiac surgery patients worldwide and the chances of survival are only 50 per cent.
The patient had undergone an aortic valve replacement in 2017 and was infected by COVID-19 in 2021.
An elderly patient in fragile health, his oxygen saturation had gone down to 87-86 for which he was put on steroids for 10 days.
He recovered, but soon after, started losing weight, and had a frequent fever and consistent coughing. As his condition started deteriorating, he underwent a CT scan and blood tests, which revealed that he had post-COVID chest fibrosis with bacteria present in the blood, said hospital officials.
On admission to Fortis Gurugram, a transesophageal echocardiogram (TEE) was conducted, and a huge fungal mass was discovered in the aortic valve of his heart.
The patient had complaints of chest heaviness with multiple comorbidities, therefore, stabilizing the patient was the first priority. Prior to the surgery, the patient's heart function had dropped to 25 per cent and he was in shock failure (Infection in the body had compromised heart function and led to difficulty in breathing), hospital officials further said.
The doctors performed a high-risk redo aortic valve replacement surgery to detoxify his body using special filters and by placing the patient on an artificial heart-lung machine to remove as much infection as possible. Today, after 3 months of the surgery, the patient is completely free of any fungal infection and is leading a healthy life.
According to Dr Dhir, "Fungal endocarditis is a very uncommon case, which happens in the aortic valve of the heart. In this patient, the fungal ball covered around 7 cm of the heart's aortic valve which is also a rare condition. In such cases, 50 per cent of people die and the success rate is low as with every heartbeat, the heavy fungal ball was popping out, which could have resulted in a major paralytic attack, a kidney or a limb problem."
"The aorta transports blood to all the body parts and with every beat, some component of the fungus was going into the blood and, therefore, to all the body parts. Platelets were also very less in number i.e. below 1,00,000 and it was tough to operate on him. As the patient had already undergone surgery of the aortic valve, we did a redo surgery with fungal endocarditis. We changed his valve and after three months, evaluated him through echocardiography, which showed that the valve is functioning fine, and there is no level of infection, as of now, in the body," Dr Dhir further said.
"The major point of this surgery was that the patient's health was quite fragile due to steroids taken for COVID, which had lowered his immunity. The culture report for this fungal infection is one of the rarest, called Candida albicans (the most prevalent cause of fungal infection in human beings). Overall, this was a very extraordinary case which is usually only found in cardiac surgery patients worldwide, and very challenging one too, due to the multiple problems involved with it," he added.