Mycotic Coronary Artery Aneurysm From Fungal Prosthetic Valve Endocarditis

Yeen, Wing; Panza, Antonio; Cook, Stephen L.; Warrell, Christopher S.; Sun, Benjamin; Crestanello, Juan A.

doi:10.1016/j.athoracsur.2007.02.005

Cited by 12 publications

(14 citation statements)

References 7 publications

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“…Small aneurysms may resolve with antibiotic therapy, whereas aneurysms greater 1 or 2 cm in diameter may enlarge and eventually rupture. 10) Therefore, aneurysms should be excised or excluded from circulation and the distal coronary artery should be revascularized.…”

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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“…Aneurysms of the coronary arteries are uncommon and are usually a result of atherosclerosis, Kawasaki disease, congenital aneurysms, arteritis, endocarditis, or a complication from cardiac catheterization. Atherosclerosis accounts for 50% of coronary artery aneurysms in adults . Mycotic aneurysms are defined as aneurysmal degeneration of the arterial wall as a result of infection such as systemic bacteremia or septic emboli.…”

mentioning

confidence: 99%

“…Atherosclerosis accounts for 50% of coronary artery aneurysms in adults. 1 Mycotic aneurysms are defined as aneurysmal degeneration of the arterial wall as a result of infection such as systemic bacteremia or septic emboli. Mycotic aneurysms of the coronary arteries are exceedingly rare and typically result from direct colonization of the arterial wall, arterial wall injury from immune complex deposition, or infarction of the vasa vasorum.…”

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confidence: 99%

The Diagnosis and Treatment of a Mycotic Coronary Artery Aneurysm: A Case Report

et al. 2013

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Aneurysms of the coronary arteries are rare and are usually associated with atherosclerosis in adults. Mycotic coronary artery aneurysms are exceedingly uncommon and are typically associated with systemic bacteremia, endocarditis, or septic emboli. Literature and data describing the management of mycotic coronary artery aneurysms are limited. This case describes the successful diagnosis of a large right coronary artery aneurysm by transesophageal echocardiogram as well as the successful management of the aneurysm.

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“…However, if the infection is active, bypass may be preferred to prevent graft infection. 3 To our knowledge, this is the first reported case of multiple mycotic coronary artery aneurysms secondary to infective endocarditis involving multiple epicardial vessels.…”

mentioning

confidence: 99%

“…These aneurysms are related to infective endocarditis and are thought to be caused by local or microembolic spread of infection to the vasa vasorum, 2 or immune complex mediated injury. 3 If left untreated, mycotic coronary artery aneurysms are at risk for rupture, thrombosis, and further embolization.…”

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confidence: 99%

A Rare Complication of Infective Endocarditis

Panagia

Winston²,

Click³

et al. 2012

Circulation

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A 65-year-old man with a permanent pacemaker placed for atrioventricular block presented to the emergency department with 4 days of fever, gastrointestinal complaints, and back pain. On presentation, he was febrile, tachycardic, and hypotensive, with a significant leukocytosis. Urine and blood cultures grew methicillin-sensitive staphylococcus aureus in 6/6 bottles. The patient was initiated on appropriate antibiotic coverage, including nafcillin, resulting in sterilization of blood cultures. Transesophageal echocardiography revealed a vegetation on the pacing wire, likely involving the tricuspid valve, necessitating removal of the pacing lead (online-only Data Supplement Movies I and II). Four weeks into his antibiotic course, continued fevers along with a new holosystolic murmur at the apex of his heart prompted repeat echocardiography, which revealed a persistent mobile echodensity on the tricuspid valve and a new mobile echodensity on the mitral valve, as well, associated with severe mitral regurgitation (online-only Data Supplement Movie III). The patient was considered for valve replacement surgery, and preoperative coronary angiography was performed. Figure 1A shows multiple mycotic aneurysms (arrows) in coronary vessels that were not present 4 months earlier ( Figure 1B). Based on the involvement of multiple epicardial vessels, and in light of the patient's clinical status (which included difficult-to-control gastrointestinal bleeding and renal insufficiency), a decision was made to treat the patient conservatively with antibiotics. The patient defervesced, remained hemodynamically stable, and finished a 12-week course of nafcillin.Despite aggressive medical management of his valvular disease, he presented to the clinic 6 months later with shortness of breath, cyanosis, ascites, and lower-extremity edema. Repeat transesophageal echocardiography revealed severe mitral regurgitation (online-only Data Supplement Movie IV) and moderate tricuspid regurgitation. He was admitted for medical optimization of his congestive heart failure before cardiac surgery. Regadenoson positron emission tomography myocardial perfusion imaging revealed a large area of ischemia in the left anterior descending and circumflex artery distributions (Figure 2). Repeat cardiac catheterization revealed enlargement and septation of the aneurysms (Figure 3). He underwent mitral valve repair with chordoplasty to A1 and A2 and coronary artery bypass grafting with left internal mammary artery to the left anterior descending artery, saphenous vein graft to the obtuse marginal artery, and saphenous vein graft to the posterior descending artery and left posterior left ventricular branch. His postoperative course was uncomplicated, his breathing improved, and repeat transthoracic echocardiography showed only mild mitral regurgitation (online-only Data Supplement

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Mycotic Coronary Artery Aneurysm From Fungal Prosthetic Valve Endocarditis

Cited by 12 publications

References 7 publications

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

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

The Diagnosis and Treatment of a Mycotic Coronary Artery Aneurysm: A Case Report

A Rare Complication of Infective Endocarditis

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