Estatísticas

 array:25 [
  "pii" => "S0870255116301378"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2015.11.028"
  "estado" => "S300"
  "fechaPublicacion" => "2016-09-01"
  "aid" => "849"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2016;35:495.e1-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4117
    "formatos" => array:3 [
      "EPUB" => 214
      "HTML" => 3302
      "PDF" => 601
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204916301313"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2015.11.035"
      "estado" => "S300"
      "fechaPublicacion" => "2016-09-01"
      "aid" => "849"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2016;35:495.e1-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3583
        "formatos" => array:3 [
          "EPUB" => 186
          "HTML" => 2745
          "PDF" => 652
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Fungal prosthetic valve endocarditis with mycotic aneurysm&#58; Case report"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "495&#46;e1"
            "paginaFinal" => "495&#46;e4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Endocardite f&#250;ngica de pr&#243;tese valvular com aneurisma mic&#243;tico&#58; caso cl&#237;nico"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figure 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 625
                "Ancho" => 950
                "Tamanyo" => 74182
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thoracoabdominal computed tomography showing pseudoaneurysm &#40;arrow&#41; in the right iliac artery&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Mariana Brand&#227;o, Jorge Almeida, Rita Ferraz, Lurdes Santos, Paulo Pinho, Jorge Casanova"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Mariana"
                "apellidos" => "Brand&#227;o"
              ]
              1 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Almeida"
              ]
              2 => array:2 [
                "nombre" => "Rita"
                "apellidos" => "Ferraz"
              ]
              3 => array:2 [
                "nombre" => "Lurdes"
                "apellidos" => "Santos"
              ]
              4 => array:2 [
                "nombre" => "Paulo"
                "apellidos" => "Pinho"
              ]
              5 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Casanova"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255116301378"
          "doi" => "10.1016/j.repc.2015.11.028"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301378?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301313?idApp=UINPBA00004E"
      "url" => "/21742049/0000003500000009/v2_201704020055/S2174204916301313/v2_201704020055/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S087025511630138X"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.11.029"
    "estado" => "S300"
    "fechaPublicacion" => "2016-09-01"
    "aid" => "850"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2016;35:497&#46;e1-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3541
      "formatos" => array:3 [
        "EPUB" => 209
        "HTML" => 2695
        "PDF" => 637
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Simple mesothelial pericardial cyst in a rare location"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "497&#46;e1"
          "paginaFinal" => "497&#46;e4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Cisto peric&#225;rdico mesotelial simples numa localiza&#231;&#227;o rara"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1323
              "Ancho" => 1750
              "Tamanyo" => 209562
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imaging of the cyst before surgery&#46; &#40;A-C&#41;&#58; Magnetic resonance imaging showing the cyst with T2-weighted hyperintense signal&#59; &#40;D and E&#41;&#58; transthoracic echocardiogram showing the location of the cyst in the interventricular septum and anechogenic appearance&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sara Ranchord&#225;s, Catarina Gomes, Miguel Abecasis, Rosa Gouveia, Jo&#227;o Abecasis, Lu&#237;s R&#46; Lopes, Paula Fazendas"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Sara"
              "apellidos" => "Ranchord&#225;s"
            ]
            1 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "Gomes"
            ]
            2 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Abecasis"
            ]
            3 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Gouveia"
            ]
            4 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Abecasis"
            ]
            5 => array:2 [
              "nombre" => "Lu&#237;s R&#46;"
              "apellidos" => "Lopes"
            ]
            6 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Fazendas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630138X?idApp=UINPBA00004E"
    "url" => "/08702551/0000003500000009/v1_201608170044/S087025511630138X/v1_201608170044/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255116301020"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.04.006"
    "estado" => "S300"
    "fechaPublicacion" => "2016-09-01"
    "aid" => "832"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Port Cardiol. 2016;35:485-94"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5408
      "formatos" => array:3 [
        "EPUB" => 198
        "HTML" => 4146
        "PDF" => 1064
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo de revis&#227;o</span>"
      "titulo" => "Organiza&#231;&#227;o e implementa&#231;&#227;o de uma consulta de cardio&#8208;oncologia"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "485"
          "paginaFinal" => "494"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Organization and implementation of a cardio&#8208;oncology program"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3642
              "Ancho" => 2508
              "Tamanyo" => 396604
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de decis&#227;o para monitoriza&#231;&#227;o e dete&#231;&#227;o de cardiotoxicidade tipo <span class="elsevierStyleSmallCaps">I</span> e tipo <span class="elsevierStyleSmallCaps">II</span> antes e durante quimioterapia &#40;adaptado de Rashi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">60</span></a>&#41;&#46; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Manuela Fiuza, Leonor Ribeiro, Andreia Magalh&#227;es, Ana Rita Sousa, Miguel Nobre Menezes, Mar&#237;lia Jorge, Lu&#237;s Costa, Fausto Jos&#233; Pinto"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Manuela"
              "apellidos" => "Fiuza"
            ]
            1 => array:2 [
              "nombre" => "Leonor"
              "apellidos" => "Ribeiro"
            ]
            2 => array:2 [
              "nombre" => "Andreia"
              "apellidos" => "Magalh&#227;es"
            ]
            3 => array:2 [
              "nombre" => "Ana Rita"
              "apellidos" => "Sousa"
            ]
            4 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Nobre Menezes"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;lia"
              "apellidos" => "Jorge"
            ]
            6 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Costa"
            ]
            7 => array:2 [
              "nombre" => "Fausto Jos&#233;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204916301301"
        "doi" => "10.1016/j.repce.2016.04.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301301?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301020?idApp=UINPBA00004E"
    "url" => "/08702551/0000003500000009/v1_201608170044/S0870255116301020/v1_201608170044/pt/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Fungal prosthetic valve endocarditis with mycotic aneurysm&#58; Case report"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "495&#46;e1"
        "paginaFinal" => "495&#46;e4"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mariana Brand&#227;o, Jorge Almeida, Rita Ferraz, Lurdes Santos, Paulo Pinho, Jorge Casanova"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Mariana"
            "apellidos" => "Brand&#227;o"
            "email" => array:1 [
              0 => "marianabrandao1993&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jorge"
            "apellidos" => "Almeida"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Rita"
            "apellidos" => "Ferraz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Lurdes"
            "apellidos" => "Santos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Paulo"
            "apellidos" => "Pinho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Jorge"
            "apellidos" => "Casanova"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Escola de Ci&#234;ncias da Sa&#250;de&#44; Universidade do Minho&#44; Braga&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Centro de Cirurgia Cardiotor&#225;cica&#44; Hospital de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servi&#231;o de Doen&#231;as Infecciosas&#44; Hospital de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Endocardite f&#250;ngica de pr&#243;tese valvular com aneurisma mic&#243;tico&#58; caso cl&#237;nico"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 546
            "Ancho" => 1750
            "Tamanyo" => 187145
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Intraoperative photographs&#58; &#40;A&#41; vegetation in the pulmonary valve &#40;arrow&#41;&#59; &#40;B&#41;&#58; infected pulmonary prosthesis&#59; &#40;C&#41; vegetation in the aortic bioprosthesis &#40;arrow&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fungal endocarditis &#40;FE&#41; is a rare condition with high mortality and poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Candida albicans</span> is the most frequent causative agent&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> Among the risk factors for fungemia and FE are prosthetic heart valves&#44; prolonged use of central venous catheters&#44; parenteral nutrition&#44; exposure to broad-spectrum antibiotics and immunosuppression&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleItalic">Candida</span> endocarditis is more commonly found in patients with prosthetic heart valves and occurs more often in patients with a history of prior endocarditis<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> and early in the postoperative period&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> Treatment includes prompt institution of antifungal therapy&#44; valve replacement and long-term eradication therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 38-year-old woman with a history of surgically corrected tetralogy of Fallot at the age of 11&#44; and recent dental procedures&#44; presented with fever&#44; anorexia&#44; weight loss and fatigue for one month and epigastric pain of recent onset&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination the patient was pale and presented with bilateral lower limb edema&#44; jugular distension and a grade II&#47;IV diastolic murmur on the left sternal border&#46; Laboratory tests showed elevated C-reactive protein &#40;CRP&#41;&#44; anemia and thrombocytopenia&#46; Blood cultures were negative&#46; Abdominal computed tomography &#40;CT&#41; revealed hepatomegaly and splenomegaly with splenic infarct&#44; thought to result from septic embolism&#46; The transthoracic echocardiogram &#40;TTE&#41; revealed an extremely mobile 15-mm vegetation on the right coronary cusp of the aortic valve and severe aortic regurgitation&#44; accompanying previously known severe dilation of the right heart chambers and pulmonary regurgitation&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A diagnosis of infective endocarditis was made and empirical antibiotic therapy was initiated with amoxicillin-clavulanate and gentamicin&#44; prior to transfer to our hospital&#46; After 17 days of antibiotic therapy&#44; signs of congestive heart failure and infection persisted and the patient was referred to our cardiothoracic surgery center&#46; Replacement of the aortic and pulmonary valves with 23- and 25-mm Carpentier-Edwards Perimount Magna<span class="elsevierStyleSup">&#174;</span> bioprostheses&#44; respectively&#44; reconstruction of the right ventricular outflow tract&#44; and tricuspid valve ring annuloplasty were successfully performed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the postoperative period&#44; the patient presented with nonoliguric acute renal failure and continuous renal replacement therapy &#40;catheter-based hemodialysis&#41; was instituted&#46; The patient was discharged 53 days after admission on a hemodialysis program and with no evidence of prosthetic infection on TTE&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Three days after discharge she was readmitted with fever and dyspnea&#44; along with elevated CRP and anemia&#46; Blood cultures were positive for <span class="elsevierStyleItalic">C&#46; albicans</span>&#46; Antifungal therapy with liposomal amphotericin B was initiated but subsequent blood cultures remained positive&#46; A transesophageal echocardiogram &#40;TEE&#41; demonstrated large vegetations on the aortic valve and a periprosthetic leak resulting in mild aortic regurgitation&#44; establishing the diagnosis of FE &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">At redo surgery the pulmonary prosthesis was also found to contain large vegetations &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; and both prosthetic valves were replaced by cryopreserved homografts&#46; Microbiological analysis of the removed tissue revealed <span class="elsevierStyleItalic">C&#46; albicans</span>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In the postoperative period blood cultures became negative and renal function recovered&#46; Due to pancytopenia&#44; liposomal amphotericin B therapy was switched to intravenous fluconazole&#46; Five days after surgery&#44; the patient suffered acute ischemia of the right lower limb and right iliofemoral embolectomy was performed by vascular surgery&#46; Direct examination of the thrombus revealed <span class="elsevierStyleItalic">C&#46; albicans</span> hyphae&#46; TTE and cardiac magnetic resonance imaging showed no signs of cardiac infection&#46; Thoracoabdominal CT revealed a pseudoaneurysm of the right iliac artery &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#44; the probable source of the emboli&#44; and the patient was reoperated&#44; with resection of the aneurysm and replacement by a segment of reversed saphenous vein&#46; Clinical pathological analysis confirmed its infectious etiology and the diagnosis of mycotic aneurysm&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The patient&#39;s condition improved and she was discharged eight weeks after the second cardiac surgery&#44; on suppressive antifungal therapy with oral fluconazole and surveillance by imaging studies and blood cultures&#46; Expected time of treatment will be at least a year&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Prosthetic valve endocarditis &#40;PVE&#41; is the most severe form of infective endocarditis&#44; accounting for 10-30&#37; of all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Health care-associated infections have been found to account for 37&#37; of PVE&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> The risk is higher in the first year after valve replacement surgery for both mechanical and bioprosthetic valves&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Fungal etiology accounts for 2-4&#37; of all cases of endocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Its incidence has increased in recent decades due to a growing number of patients at risk&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> It is associated with worse prognosis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> and 50&#37; mortality rate despite treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">PVE is a diagnostic challenge&#58; the modified Duke criteria<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> lack sensitivity in this context&#44; blood cultures are more often negative and echocardiography has less diagnostic accuracy&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Therefore&#44; a high index of suspicion is needed for its diagnosis&#44; in order to enable early initiation of therapeutic measures that can improve the prognosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the case reported&#44; no vegetations were identified in the pulmonary prosthesis by echocardiography&#46; This is presumably due to the poor visualization of the pulmonary prosthesis by TEE and to its lower sensitivity in cases of PVE&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">TEE is more sensitive and useful in cases of PVE&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> FE usually leads to larger vegetations than those found in bacterial endocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> As a result&#44; arterial embolization&#44; as presented by our patient&#44; is more common&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> the usual sites being the cerebral circulation&#44; extremities and gastrointestinal tract&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No randomized studies have assessed the optimal therapy for fungal PVE&#46; The therapeutic approach is based on antifungal agents and valve replacement surgery&#44; although successful treatments of FE have been reported with medical therapy alone&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> Moreover&#44; no uniform recommendations are available concerning the most appropriate antimicrobial regimen&#44; the ideal timing for surgery or the total duration of treatment&#46; According to the ESC guidelines&#44; surgery may be undertaken on an elective or urgent basis depending on the patient&#39;s condition&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> although others recommend earlier surgery&#44; as it appears to improve outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> In the case presented&#44; an initial approach with antifungal therapy was adopted&#44; due to the high risk associated with a third cardiac surgery &#40;EuroSCORE II of 38&#46;5&#41;&#44; but the persistent fungemia made surgery advisable&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In our patient&#44; amphotericin B was used in a lipid formulation to avoid further deterioration of renal function&#44; but the development of pancytopenia forced conversion to fluconazole&#46; Since the potential for recurrent infection is extremely high in fungal PVE&#44; suppressive therapy with fluconazole is recommended for prolonged periods or even indefinitely&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Given the high recurrence rate of FE&#44; the use of homografts is justified by their higher resistance to recurrent infection&#46; This advantage may be explained by the suggestion that homografts have the ability to reproduce collagen&#44; improving postoperative local healing&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> Homografts allow complete debridement of all infected tissue and better tissue penetration of antimicrobial agents&#44; facilitating eradication of the infection&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The source of our patient&#39;s candidemia is unclear&#44; but the long hospitalization&#44; the presence of a recent implanted prosthetic valve&#44; and an indwelling central venous catheter for the hemodialysis program represent risk factors that may explain it&#46; The patient&#39;s congenital heart disease is also a predisposing factor for infective endocarditis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In this case numerous predictors of poor outcome were present&#44; besides the fungal etiology of a prosthetic valve infection&#46; These included the clinical manifestations of congestive heart failure&#44; the long period of hospitalization with central venous catheters&#44; renal failure requiring hemodialysis&#44; the large size of the fungal vegetations&#44; carrying higher embolic risk&#44; and finally the mycotic pseudoaneurysm of the right iliac artery&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">FE caused by <span class="elsevierStyleItalic">C&#46; albicans</span> is a rare condition with poor prognosis&#46; The presence of a prosthetic valve and a central venous catheter are major risk factors for FE&#46; The diagnosis is challenging as only about half of blood cultures are positive and the sensitivity of echocardiography in prosthetic valve endocarditis is limited&#46; Despite the lack of evidence from randomized clinical trials&#44; treatment combining antifungal therapy and valve replacement is thought to offer improved clinical outcomes&#46; The timing of surgery is not consensual but early surgery appears to improve survival&#44; depending on the patient&#39;s clinical condition&#46; Moreover&#44; given the high recurrence rate of fungal PVE&#44; homografts appear to be the most appropriate choice&#44; providing the highest resistance to recurrent infection&#44; by allowing complete debridement of infected tissue with low risk of valve dehiscence and better antibiotic penetration&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres719053"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec724231"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres719054"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec724232"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-08-17"
    "fechaAceptado" => "2015-11-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec724231"
          "palabras" => array:5 [
            0 => "Fungal endocarditis"
            1 => "Prosthetic valve endocarditis"
            2 => "<span class="elsevierStyleItalic">Candida albicans</span>"
            3 => "Homografts"
            4 => "Mycotic aneurysm"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec724232"
          "palabras" => array:5 [
            0 => "Endocardite f&#250;ngica"
            1 => "Endocardite de pr&#243;tese valvular"
            2 => "<span class="elsevierStyleItalic">Candida albicans</span>"
            3 => "Homoenxertos"
            4 => "Aneurisma mic&#243;tico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis&#44; with poor prognosis and high mortality despite treatment&#46; <span class="elsevierStyleItalic">Candida albicans</span> is the most common etiological agent for this rare but increasingly frequent condition&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present a case of fungal prosthetic valve endocarditis due to <span class="elsevierStyleItalic">C&#46; albicans</span> following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot&#44; prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis&#46; Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery&#44; in which the bioprostheses were replaced by homografts&#44; providing greater resistance to recurrent infection&#46; During hospitalization&#44; a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia&#44; requiring two vascular surgical interventions&#46; Despite the complications&#44; the patient&#39;s outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The reported case illustrates multiple risk factors for fungal endocarditis&#44; as well as complications and predictors of poor prognosis&#44; demonstrating its complexity&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A endocardite f&#250;ngica de pr&#243;tese valvular &#233; uma forma extremamente severa de endocardite infeciosa&#44; com mau progn&#243;stico e elevada mortalidade apesar do tratamento m&#233;dico&#46; <span class="elsevierStyleItalic">Candida albicans</span> &#233; o agente etiol&#243;gico mais frequentemente implicado nesta rara&#44; embora crescente&#44; patologia&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Relata-se um caso de endocardite f&#250;ngica de pr&#243;tese valvular ap&#243;s substitui&#231;&#227;o das v&#225;lvulas a&#243;rtica e pulmonar numa mulher de 38 anos com antecedentes de tetralogia de Fallot cirurgicamente corrigida&#44; endocardite infeciosa pr&#233;via e insufici&#234;ncia renal aguda com necessidade de hemodi&#225;lise por cat&#233;ter&#46; A terap&#234;utica antif&#250;ngica com anfotericina B liposs&#243;mica foi iniciada previamente &#224; cirurgia card&#237;aca&#44; onde as biopr&#243;teses foram substitu&#237;das por homoenxertos&#44; conferindo maior resist&#234;ncia &#224; infe&#231;&#227;o recorrente&#46; Durante o internamento&#44; foi diagnosticado um aneurisma mic&#243;tico&#44; na sequ&#234;ncia de um epis&#243;dio de isquemia arterial aguda&#44; obrigando a duas interven&#231;&#245;es pela Cirurgia Vascular&#46; Apesar das complica&#231;&#245;es&#44; a doente teve um bom <span class="elsevierStyleItalic">outcome</span> cl&#237;nico e recebeu alta com terap&#234;utica de erradica&#231;&#227;o com fluconazol durante&#44; pelo menos&#44; um ano&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O caso relatado enumera m&#250;ltiplos fatores de risco para endocardite f&#250;ngica&#44; assim como complica&#231;&#245;es e preditores de mau progn&#243;stico&#44; ilustrando a sua complexidade&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 710
            "Ancho" => 950
            "Tamanyo" => 72893
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram&#44; long-axis aortic valve plane&#44; demonstrating the presence of a vegetation in the aortic prosthesis &#40;arrow&#41;&#46; Ao&#58; ascending aorta&#59; LA&#58; left atrium&#59; LV&#58; left ventricle&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 546
            "Ancho" => 1750
            "Tamanyo" => 187145
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Intraoperative photographs&#58; &#40;A&#41; vegetation in the pulmonary valve &#40;arrow&#41;&#59; &#40;B&#41;&#58; infected pulmonary prosthesis&#59; &#40;C&#41; vegetation in the aortic bioprosthesis &#40;arrow&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 625
            "Ancho" => 950
            "Tamanyo" => 74182
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thoracoabdominal computed tomography showing pseudoaneurysm &#40;arrow&#41; in the right iliac artery&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:14 [
            0 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines on the prevention&#44; diagnosis&#44; and treatment of infective endocarditis &#40;new version 2009&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Habib"
                            1 => "B&#46; Hoen"
                            2 => "P&#46; Tornos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehp285"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "2369"
                        "paginaFinal" => "2413"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19713420"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fungal endocarditis&#58; evidence in the world literature&#44; 1965-1995"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;E&#46; Ellis"
                            1 => "H&#46; Al-Abdely"
                            2 => "A&#46; Sandridge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/317550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "32"
                        "paginaInicial" => "50"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11118386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fungal endocarditis&#44; 1995-2000"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;C&#46; Pierrotti"
                            1 => "L&#46;M&#46; Baddour"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "122"
                        "paginaInicial" => "302"
                        "paginaFinal" => "310"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12114375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Candida infective endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Baddley"
                            1 => "D&#46;K&#46; Benjamin"
                            2 => "M&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10096-008-0466-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "27"
                        "paginaInicial" => "519"
                        "paginaFinal" => "529"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18283504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical and long-term antifungal therapy for fungal prosthetic valve endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;D&#46; Muehrcke"
                            1 => "B&#46;W&#46; Lytle"
                            2 => "D&#46;M&#46; Cosgrove"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(95)00469-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1995"
                        "volumen" => "60"
                        "paginaInicial" => "538"
                        "paginaFinal" => "543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7677477"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510971404546X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary clinical profile and outcome of prosthetic valve endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Wang"
                            1 => "E&#46; Athan"
                            2 => "P&#46;A&#46; Pappas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.297.12.1354"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2007"
                        "volumen" => "297"
                        "paginaInicial" => "1354"
                        "paginaFinal" => "1361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17392239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults&#58; a report of the Working Party of the British Society for Antimicrobial Chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;K&#46; Gould"
                            1 => "D&#46;W&#46; Denning"
                            2 => "T&#46;S&#46;J&#46; Elliott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkr450"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2012"
                        "volumen" => "67"
                        "paginaInicial" => "269"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22086858"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fungal endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Tacke"
                            1 => "P&#46; Koehler"
                            2 => "O&#46;A&#46; Cornely"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QCO.0000000000000009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Infect Dis"
                        "fecha" => "2013"
                        "volumen" => "26"
                        "paginaInicial" => "501"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24126720"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Li"
                            1 => "D&#46;J&#46; Sexton"
                            2 => "N&#46; Mick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/313753"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2000"
                        "volumen" => "30"
                        "paginaInicial" => "633"
                        "paginaFinal" => "638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10770721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Candida prosthetic valve endocarditis&#58; prospective study of six cases and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;H&#46; Nguyen"
                            1 => "M&#46;L&#46; Nguyen"
                            2 => "V&#46;L&#46; Vu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1996"
                        "volumen" => "22"
                        "paginaInicial" => "262"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8838182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fungal endocarditis with central and peripheral embolization&#58; case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Ribeiro"
                            1 => "A&#46; Gaspar"
                            2 => "A&#46; Assun&#231;&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2011.12.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "449"
                        "paginaFinal" => "453"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22595014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Candida prosthetic valve endocarditis cured by caspofungin therapy without valve replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Rajendram"
                            1 => "N&#46;J&#46; Alp"
                            2 => "A&#46;R&#46; Mitchell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2005"
                        "volumen" => "40"
                        "paginaInicial" => "72"
                        "paginaFinal" => "74"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESCMID guideline for the diagnosis and management of Candida diseases 2012&#58; non-neutropenic adult patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46;A&#46; Cornely"
                            1 => "M&#46; Bassetti"
                            2 => "T&#46; Calandra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1469-0691.12039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Infect"
                        "fecha" => "2015"
                        "volumen" => "18"
                        "paginaInicial" => "19"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23137135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Niwaya"
                            1 => "C&#46;J&#46; Knott-Craig"
                            2 => "K&#46; Santangelo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1999"
                        "volumen" => "67"
                        "paginaInicial" => "1603"
                        "paginaFinal" => "1608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10391262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003500000009/v1_201608170044/S0870255116301378/v1_201608170044/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29263"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000009/v1_201608170044/S0870255116301378/v1_201608170044/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301378?idApp=UINPBA00004E"
]