In rare surgery, doctors remove fungal ball from Long Covid patient’s heart

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As we still continue to grapple with what Long Covid is, an odd case here and there continues to surprise doctors.

Least of all, you do not expect a rulebook patient to throw up one. But 70-year-old Suresh Chandra was one such.

Having undergone an aortic valve replacement in 2017 and infected by COVID-19 last year, he meticulously did follow-up tests and screening. That’s how he could be treated for chest fibrosis and a bacterial infection in the blood well within time. But no test indicated a fungal ball, which had developed in his aortic valve. It was too late but a complex and innovative surgery later, he has lived to see another day.

Said Dr Udgeath Dhir, Director and Head of Cardiothoracic and Vascular Surgery (CTVS), Fortis Memorial Research Institute, who performed the complex procedure, “He had a rare condition called fungal endocarditis, only found in a fraction of cardiac surgery patients worldwide. The chances of survival are only 50 per cent. An elderly patient in fragile health, his oxygen saturation during COVID had gone down to 87-86 for which he was put on steroids for 10 days. He recovered, but soon after, started losing weight, had 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. He was treated for these conditions but he didn’t quite regain his health. He did PET scans too. Name the test and he did it. When he came to us after doing the rounds of several doctors, he was frail, weighing just 45 kg. He complained of breathlessness, had a high fever of 105 degrees, a low platelet and haemoglobin count.”

A blood culture showed fungal infection. Given his cardiac history, doctors conducted a trans-esophageal echocardiogram (TEE) and discovered a huge fungal mass in the aortic valve of his heart. The patient had complaints of chest heaviness with multiple comorbidities. So, stabilising him 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). The doctors performed a high-risk redo aortic valve replacement surgery to detoxify his body using special filters and by placing him on an artificial heart lung machine to remove as much infection as possible.

“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 fell 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 was functioning fine, and there was no level of infection in the body,” said Dr Dhir.

“The growth could have been brought on by multiple factors resulting from a post-COVID immunity-compromised body. The patient’s health was quite fragile due to steroids taken for COVID. The culture report for this fungal infection is one of the rarest, called Candida albicans (most prevalent cause of fungal infection in human beings). Overall, this was a very extraordinary case which is usually found in very few cardiac surgery patients worldwide,” he added.

The doctors were apprehensive even after the surgery was a success. They waited three months after the surgery and declared the patient completely free of any fungal infection and capable of leading a healthy life. But Dr Dhir has advised strict compliance with follow-ups to prevent any complications. “Chandra now weighs around 63 kg. He is an alumnus of IIT Roorkee and it helped that he had a scientific temperament and understood risks. Also his mental health profile was top-notch. He was determined to make it through,” said Dr Dhir.





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