Obstruction of a percutaneous pulmonary valve by an Aspergillus mycotic thrombus mimicking massive pulmonary embolus.

Abstract

New technologies in the management of congenital and acquired heart disease may be associated with unfamiliar complications that may require repeated surgical intervention. A high index of suspicion for unusual problems and close collaboration between cardiologists and surgeons is essential when adopting evolving technologies. We report the case of near total obstruction of a 2.5-month-old implanted Melody percutaneous pulmonary valve (PPV) with a thrombus mimicking saddle embolus causing right heart failure and hemodynamic collapse. This obstruction necessitated emergency surgery and homograft replacement. Cultures and pathologic examination revealed fungal thrombus with Aspergillus fumigatus. Subsequently, the patient had rapid improvement, received antifungal treatment, and has shown excellent cardiac and systemic recovery up to 1 year after surgery.