Reconstruction of the right atrium using an extracellular matrix patch in a patient with severe mediastinal aspergillosis

Abstract

Introduction: We report a case of reconstruction of the right atrial wall using a novel bioresorbable patch derived from porcine small intestinal submucosa.

Presentation of case: Our patient presented with mediastinal aspergillosis as a result of chronic steroid therapy for an oligodendroglioma. Hemodynamic compromise and syncopal episodes secondary to the mass effect of the aspergilloma prolapsing through tricuspid valve necessitated palliative surgical excision.

Discussion: Intraoperatively, it was confirmed that the lesion had eroded into the right atrium and partially occluded right ventricular inflow. In order to achieve appropriate palliation a wide resection of the atrial wall was necessary. The atrial reconstruction was then performed using an extracellular matrix-derived biopatch. This case was further complicated by postoperative bleeding requiring re-operation.

Conclusion: We describe the methods used for repair using a novel patch in this rare case of invasive aspergillosis extending into the right atrium and resulting in compromise of diastolic right ventricular filling.