Mycotic aneurysm of the left main coronary artery producing acute coronary occlusion and purulent pericarditis

Westover, Kenneth D.; Benedick, Bruce A.

doi:10.1016/j.ijcard.2006.04.059

Cited by 11 publications

(10 citation statements)

References 4 publications

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“…The surgical treatment is most widely used to avoid complications including thrombosis, rupture, and coronary embolization. 6) Various surgical strategies have been adopted, such as reconstruction, resection, or isolation with concomitant coronary artery bypass grafting. [7][8][9] The natural history of mycotic coronary aneurysms is unclear.…”

Section: Discussionmentioning

confidence: 99%

Mycotic Left Main Coronary Artery Aneurysm Following Double-Valve Replacement for Active Infective Endocarditis

Matsuno

Fukumoto

Ishida

et al. 2013

Ann Thorac Cardiovasc Surg

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A 68-year-old man underwent double-valve replacement (DVR) for active infective endocarditis caused by Enterococcus faecalis. Postoperative coronary angiography (CAG) revealed a saccular aneurysm originating from the distal portion of LMCA with severe stenosis at the ostium of the left anterior descending (LAD) artery and left circumflex artery (LCx). Emergent surgical resection with concomitant coronary artery bypass grafting were performed. Mycotic coronary artery aneurysms have a great tendency to rupture, and this may result in cardiac tamponade and sudden death. Early recognition and prompt surgical intervention is mandatory to minimize those fatal complications.Keywords: coronary artery aneurysm, mycotic, left main coronary artery, infective endocarditisWe present a case of successful treatment for mycotic left main coronary artery aneurysm following doublevalve replacement for infective endocarditis. Case ReportA 68-year-old man was referred to our hospital with high grade fever. He had a history of self-catheterization due to neurogenic bladder and obstructive nephropathy. Transthoracic echocardiography (TTE) confirmed severe aortic and mitral regurgitation with vegetations and severe destruction on both of those valves. Blood cultures on admission were positive for Enterococcus faecalis, and; therefore, intravenous administration of ampicillin sodium and gentamicin sulfate was initiated for active infective endocarditis. Although further investigation of the aortic root and coronary arteries was considered, cardiac catheterization was avoided because of the friable vegetation of the aortic valve. Progressive heart failure necessitated emergent surgical intervention. And then he underwent double-valve replacement (DVR) with bileaflet mechanical valves (#21 and #31, St Jude Medical Inc., USA for aortic and mitral valve, respectively). Following surgery, the antibiotic treatment was continued, and body temperature fell down with decreased white blood cell

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Section: Discussionmentioning

confidence: 99%

Mycotic Left Main Coronary Artery Aneurysm Following Double-Valve Replacement for Active Infective Endocarditis

Matsuno

Fukumoto

Ishida

et al. 2013

Ann Thorac Cardiovasc Surg

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“…Coronary artery aneurysms are rare, with an incidence ranging between 1.4% in an autopsy series and 4.9% in an angiography series . They are most commonly associated with atherosclerosis in adults, and Kawasaki disease in children, with less common causes being congenital malformations, trauma, dissection, connective tissue disorders, systemic lupus erythematous and complications of coronary angioplasty, and vasculitis . Mycotic aneurysms of the coronary arteries are extremely rare, accounting for less than 3% of all coronary aneurysms, with the first case reported in 1812 .…”

Section: Commentmentioning

confidence: 99%

“…While it is thought smaller aneurysms may be managed conservatively with long‐term antibiotic therapy, larger aneurysms require surgical management . Given the inherent risk of enlargement of the aneurysm and subsequent rupture, the treatment modality of choice for mycotic aneurysms of the coronary arteries has been surgery since the first successful procedure in 1970 . Although the timing of surgery is not well defined, the literature supports urgent aneurysmal resection and CABG to avoid the risks of aneurysmal rupture …”

Section: Commentmentioning

confidence: 99%

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Mycotic Pseudoaneurysms of the Coronary Arteries

et al. 2015

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“…The pathogenesis of purulent pericarditis involved either contiguous spreading or hematogenous seeding. In recent issues of the journal, several routes of pericardial infection have been reported, such as hematogenous seeding from meningococcal meningitis [1], contiguous spreading from intrathoracic infection [2], and direct extension from intracardiac infection [3]. The most common routes of spreading were via contiguous spreading from intrathoracic infection.…”

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confidence: 99%