Paul R. Vogt1*, Elisabeth Hasler2, Daniel Schmidlin3, Pascal Berdat1, Phillip Th. Went4, Markus Flepp5 and Paul Mohasci6
1Department of Cardiovascular Surgery, Klinik Im Park, Switzerland
2Department of Pneumology, University Hospital Zurich, Switzerland
3Department of Anaesthesia and Intensive Care, Klinik Im Park, Switzerland
4Pathology Institute Enge, Switzerland
5Department of Infectious Diseases, Klinik Im Park, Switzerland
6Department of Cardiology, Klinik Im Park, Switzerland
A 66-year old man after orthotopic heart transplantation developed severe infection with Aspergillus fumigates covering the entire thoracic cavity with a thick fungal turf. Repeated surgical removal of infectious and necrotic tissue together with innovative topical treatment using voriconazole and chlorhexidine combined with systemic antifungal treatment lead to elimination of the infection. Definite wound closure was achieved by latissimus dorsi muscle flap plasty and standard sterna refixation. To the best of our knowledge, we report the first survival of extensive A.fumigatus mediastinitis after heart transplantation due to repeated debridement in combination with novel topical application of antifungal agents.
Aspergillus fumigatus; Fungal Infection; Heart transplant; Immunosuppression; Mediastinitis; Mycotic aneurysm; Topical treatment; Chlorhexidine; Voriconazole
Vogt PR, Hasler E, Schmidlin D, Berdat P, Went PTh, Flepp M, et al. Mycotic Aneurysm of the Ascending Aorta and Aspergillus Fumigatus Mediastinitis Early after Cardiac Transplantation. Clin Surg. 2017; 2: 1681.