Candida (fungus) growing on bovine valve

[Guest]

Hello everyone,
My Dad (78 y. o.) received a Bovine valve to replace his aortic valve nearly a year ago. A few weeks after surgery he was told he had a fungal or yeast infection in his blood called candida. We thought we had it licked, but 4 months ago it was found growing on his valve. Agressive IV therapy etc. have not eradicated it and now the valve is leaking. He is debilitated by all this and being told the only way to get rid of it is resurgery, but at the same time being told re-surgery is very high risk and an extensive recovery. Any that can share info is much appreciated. Some very hard choices need to be made. Thanks. Jim

 

[ShezaGirlie]

Hi there Jim and welcome..

Here's a start for you in doing your research. There are valves being replaced by percutaneous means for folks who are in a weakened state. Cleveland Clinic is the premier heart center in the world. I hope you can get your father there when/if he needs a replacement.

Here's the link:

http://my.clevelandclinic.org/heart/percutaneous/percutaneousValve.aspx

 

[Lynlw]

Im, sorry to hear about your father. Fungus infections can be so tough to wipe out. Not that it really matters now, but did they do blood cultures after they thought the fungus was gone? I think once it moves to a valve, the only way to get rid of it is surgery to remove the valve, I don't think they could do percutaneous replacement, because they would probably want the infected valve out. REDOs do have an increased risk, but depending on what kind of shape your Dad is in over all, a REDO itself shouldn't be that much worse IF he goes to a hospital that not only has alot of experience with REDOs, but treating fungus infections. I think the fungus is the biggest concern right now. Do you know if it is still in his blood, or does it seem to "just"( and I know in this case just is a big deal) be on his valve? Where is he being treated now? I see you live in Mass, does your Dad live there also? He really does need to go to one of the Best heart centers who have alot of experience with high risk patients.
My son is MUCH younger, but I know how frustrating and scarey these infections can be, he has had both Endocarditis (that he didn't need another surgery for) and a sternal infection that wasn't fungus, but a weird strain of staph, that came back 2 1/2 years after he thought it was gone.

 

[tobagotwo]

Brigham and Womens and Mass General are two of the top heart centers in the country. They should have a percutaneous valve program at one of them.

Just a note: I used to live in Weston when I was a youngster.

I wish your father well.

 

[Nancy]

would percutaneous valve replacement be appropriate for a valve that is infected?

 

[Lily]

Hi Jim - I was thinking about the percutaneous valve as I read your question too. So sorry for what you and your dad and family are going through. Hoping it all goes well for him. Please keep us posted

 

[Lynlw]

Brigham and Womens and Mass General are two of the top heart centers in the country. They should have a percutaneous valve program at one of them.

Just a note: I used to live in Weston when I was a youngster.

I wish your father well.

They both are part of the trials http://clinicaltrials.gov/ct2/show/study/NCT00530894?term=sapien&rank=2&show_locs=Y#locn And even if your Father couldn't have percutaneous valve, I still would get a 2nd opinion from either of them.

I didn't think you could do them with an infected valve (I thought they would probably want the infected valve out) so checked the eligibility for the trials and under Exclusion Criteria
"Echocardiographic evidence of intracardiac mass, thrombus or vegetation"

FWIW, I did read an abstract in pubmed in Italy They used it for an elderly man with BE, but I don't know what the infection was caused by OR if the infection was cleared up before the surgery. http://www.ncbi.nlm.nih.gov/pubmed/20303189

 

[tobagotwo]

Good point, Lyn and Nancy. I wasn't thinking along those lines. Your experiences with the medical system are really valuable, especially in situations like this.

They might want the old valve out, even if they think they've cured it. However, it's systemic: in his blood, so I'm not sure the infection can be cut out. It would seem they need to control it first, no matter what they do. It's really a cruel turn, to lose a valve so soon.

Best wishes,

 

[Nancy]

Jim, I had a couple of thoughts. First off, I think an Infectious Disease specialist should be called in to assess your dad's problem. I would think they would want the infection under very good control before any surgery is anticipated, because surgery could stir up a hornet's nest again. He should be in the best possible shape before any surgery.

I also think you need to get a handle on just how debillitated your dad is from all this, and get a reaslitic idea of the risk factors of doing surgery versus the risk factors of not doing it.

It sounds as if his doctors have said that there are significant risks, but they did not say they would not do surgery.

My husband needed a fourth surgery, but was extremely debillitated from several co-morbidities. In his case, surgeons and his cardiologist absolutely refused to do any more surgery on him. So, they can give you a very good idea of what could be expected. And I think if they thought he had no chance, they would have told you that surgery was not an option. But of course, one never knows.

I can tell you that if it were my husband, he would have opted for surgery. He always said that if there was a chance that it could be corrected, he had to take that chance. So, a lot depends on how your dad feels about this situation combined with what you can find out from a couple of his doctors plus an Infectious Disease specialist. But if he goes in that direction, he has to make sure that every effort is made to provide him the best possibility for survival.

As hard as this sounds, you and your dad have to be very pragmatic about this, along with hhis doctors. And you might have to push very hard to get them to all cooperate and come to a sensible plan.

 

[Lynlw]

Good point, Lyn and Nancy. I wasn't thinking along those lines. Your experiences with the medical system are really valuable, especially in situations like this.

They might want the old valve out, even if they think they've cured it. However, it's systemic: in his blood, so I'm not sure the infection can be cut out. It would seem they need to control it first, no matter what they do. It's really a cruel turn, to lose a valve so soon.

Best wishes,

Thats what I was trying to figure out, if it was still in his blood.

 

[Guest]

Hi everyone and thank you so much for your very fast responses. WOW! First off I'll fill in a few blanks. Dad is being aggressively treated for the fungus by the chief of I.D. He is in a Boston hospital, St. Elizabeth's (remember the TV show St. Elseware). The fungus is now controlled, cleared the bloodstream and other infected areas except the artificial material. Still on very strong I.V. drugs. He is quite weak (lost 25 lbs since May, and not an acceptable risk for resurgery yet. Will get reevaluated in 4-6 weeks. I will certainly call in folks from Brigham and Mass. Gen thanks for that info. Hopefully, the valve and aortic root (also replaced and now infected) will behave until then. Percutaneous method is not an option as all the old stuff has to come out. Reinfection of the new valve is also a concern. One surgeon flat refused to do anything because of that. I.D. docs, cardiology, surgery, ICU specialist, lots of residents, everybody has an opinion but no answers. He got this bad because they went to their Florida home for the winter and no one ever told them the fungus could come back or how dangerous that would be.

 

[Lynlw]

I am so sorry to hear about this. I know often for fungus especially soon after heart surgery they keep you on the anti fungal meds for a very long time, even a year or so. Hopefully one of the other hospitals can igive you a little more hope.

 

[ALCapshaw2]

Jim -

This is the first I've heard of a Candida infection of the valve.

Out of curiosity, do your father's Doctors have any idea how he acquired the candida infection in the first place?

'AL Capshaw'

 

[Guest]

AL, if they do they're not saying. A few guesses and finger pointing. The big problem is that they assumed it was eradicated last fall. Dad was never given any instruction about symptoms, follow-ups, or anything other than go to Florida and get healthy. The infection returned and went untreated for nearly five months. He felt sick but didn't know why. Saw one doc in Fl. who did nothing. By the time he got home it was systemic and causing lots of problems. Everything is coming back around now except the valve. It has "vegetation" on it and is leaking. He also has a small hole in the heart muscle where the valve attaches. Warning to all VR folks! Take any terms like vegetation, yeast, fungus, and/or candida very very seriously. Insist on lifetime suppressive antifungal therapy.

 

[Lynlw]

Unfortunately Candida infections are pretty common since it can grow pretty much any where on you so is easy to cause an infection.
It is such a shame it got into his blood to start with, but I've heard of that and usually it gets taken care of so hopefully doesn't get on a valve (or wires anything you still have after surgery) and that's it.
I agree Jim, sadly many people don't realize HOW dangerous alot of these things can be until they or someone they love run into problems. There are a few members who've had to have valves replaced, because of Bacterial Endocarditis, (BE which I put in posts before, sorry I abbreviated) but not fungal, some of the members it caused their 1st surgery but others the surgery because of infection was their 2nd or 3rd.
It is AWFUL knowing your Dads recent history with both heart surgery AND the fungus, the Doctor in Florida didn't run the test to make sure the infection wasn't back.
BUT the good thing is you Dad was diagnosed with his infection and with treatment the fungus is not in his blood anymore (which is a big Blessing) Now hopefully he can start recovering and getting in a little better shape to he can go into surgery in the best shape as possible.
Since he IS in a smaller hospital, I don't know if you have any of the power to call doctors, make arrangements, or if your Mom has to BUt I would put calls into both Brigman and Mass General and try to get their opinions now, they may want to do something different medicine- wise, or perhaps since they have more experience with higher risks patients, they might prefer to operate now, since the fungus is not in his blood instead of waiting another month or so. IF they agree with what is the plan now, at least you would know that too, which would make me feel better if it were my loved one
I wish you the best and please keep us updated.

ps yes I remeber st elswhere I loved it and was so bummed when it turned out all to be in the little boys snowglobe imagination.

 

[Guest]

Thank you Lyn. I have a list of heart surgeons now at Mass. Gen and Brigham. I'll work on that angle today. Good advice. Dad's docs are looking to ship him out to some Rehab place soon so I have that to work on also. Of course, all this while I am at work today, LOL. Definition of middle age: When your spouse, parents, kids, and grand kids all want you at the same time. Again thanks to you and all.

 

[Guest]

Sorry, I haven't kept this thread going, but I have been very busy with Dad in Mass. Sadly, he lost his battle after 5 months fighting the infection and past away on Sept. 4th. A few days short of a year after his valve surgery and one day after his 79th birthday and 59th anniversary. The SOB doctors didn't even send a card.

 

[tprice54]

I'm sorry for your loss. I have followed your thread as it was the first time I've heard of this particular infection and tissue valves. May I say your posting may help save some lives in the future, as we are now more aware of this. Prayers your way.............

 

[nngbwh]

So sorry to hear about your dad. Prayers your way. Take care.

 

[Duffey]

I'm so sorry to read that your father passed away. Please accept my sincere condolences.