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Monin A, Didier R, Leclercq T, Chagué F, Rochette L, Danchin N, Zeller M, Fauchier L, Cochet A, Cottin Y. Coronary artery embolism and acute coronary syndrome: A critical appraisal of existing data. Trends Cardiovasc Med 2024; 34:50-56. [PMID: 35868593 DOI: 10.1016/j.tcm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
The occurrence of coronary artery embolism (CE) has been associated with various clinical conditions, including aortic and mitral prosthetic heart valve implantation, atrial fibrillation (AF), dilated cardiomyopathy, neoplasia, infective endocarditis, atrial septal defect, cardiac tumors, and hypercoagulable states. CE is also a rare cause of myocardial infarction (MI), with a prevalence of about 5%, a figure probably underestimated. The purpose of this article was to determine the current state of knowledge on acute coronary syndrome (ACS) related to CE. We thus performed a comprehensive structured literature search of the MEDLINE database for articles published between 1 January 1990 and 31 December 2021. The diagnosis of CE remains difficult despite the currently used Shibata classification, which is based on major criteria, including angiographic characteristics: globular filling defects, saddle thrombi or multiple filling defects and absence of atherosclerosis in the coronary arteries. Suspected or confirmed CE requires the identification of an etiology. There are only two published series on CE, including about 50 cases each. The three main causes in these series were: 1) atrial fibrillation (73% vs 28.3%), 2) cardiomyopathy (9.4% vs 25%) and 3) malignancy (9.6% vs 15.1%). Finally, 26.3% of the MI patients with CE had no identifiable cause of CE. When anatomically possible, analyzing the thrombus after thrombectomy may help. MI due to CE requires systematic assessment of other locations, i.e. multiple coronary and extracardiac locations. Simultaneous systemic embolization to the brain (67%), limbs (25%), kidneys (25%) or spleen (4%) is frequent, occurring in approximately 25% of CE-related MI. In the setting of acute MI, CE is associated with significant morbidity and mortality. Coronary artery thromboembolism is a rare, non-atherosclerotic, cause of ACS, and prospective studies are needed to evaluate a systematic diagnostic approach and personalized therapeutic strategies.
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Affiliation(s)
- Antoine Monin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Romain Didier
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Thibault Leclercq
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Frédéric Chagué
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Luc Rochette
- PEC2, EA 7460, University of Burgundy, Dijon, France
| | - Nicolas Danchin
- Department of Cardiology, University Teaching Hospital of Georges Pompidou, Paris, France
| | - Marianne Zeller
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France; PEC2, EA 7460, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and François Rabelais University, Tours, France
| | - Alexandre Cochet
- Department of Magnetic Resonance Imaging, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France.
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Knol WG, Wahadat AR, Roos-Hesselink JW, Van Mieghem NM, Tanis W, Bogers AJJC, Budde RPJ. Screening for coronary artery disease in early surgical treatment of acute aortic valve infective endocarditis. Interact Cardiovasc Thorac Surg 2021; 32:522-529. [PMID: 33331646 PMCID: PMC8906775 DOI: 10.1093/icvts/ivaa313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In patients with unknown coronary status undergoing surgery for acute infective endocarditis (IE), the need to screen for coronary artery disease (CAD) and the risk of embolization during invasive coronary angiography (ICA) are debated. Coronary computed tomography angiography (CCTA) is a non-invasive alternative in these patients. We aimed to evaluate the safety and feasibility of ICA and CCTA to diagnose CAD, and the necessity to treat CAD to prevent CAD-related postoperative complications. METHODS In this single-centre retrospective cohort study, all patients with acute aortic IE between 2009 and 2019 undergoing surgery were selected. Outcomes were any clinically evident embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization and postoperative renal function. RESULTS Of the 159 included patients, CAD status was already known in 14. No preoperative diagnostics for CAD was done in 46/145, a CCTA was performed in 54/145 patients and an ICA in 52/145 patients. Significant CAD was found after CCTA in 22% and after ICA in 21% of patients. In 1 of the 52 (2%) patients undergoing preoperative ICA, a cerebral embolism occurred. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 2% (1 out of 46 patients). CONCLUSIONS Although the risk of embolism after preoperative ICA is low, it should be carefully weighed against the estimated risk of CAD-related perioperative complications. CCTA can serve as a gatekeeper for ICA in most patients with acute aortic IE.
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Affiliation(s)
- Wiebe G Knol
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Ali R Wahadat
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
- Department of Cardiology, Haga Hospital, the Hague, Netherlands
| | | | | | - Wilco Tanis
- Department of Cardiology, Haga Hospital, the Hague, Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
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3
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Ioannou P, Alexakis K, Kofteridis DP. Endocarditis in kidney transplant recipients: a systematic review. J Chemother 2020; 33:269-275. [PMID: 33327869 DOI: 10.1080/1120009x.2020.1861512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infective Endocarditis (IE) carries significant mortality. Bacteremia, which is a predisposing factor for IE, occurs more frequently in immunocompromised individuals. Interestingly, IE in kidney transplant recipients has not been adequately described. The aim of this study was to systematically review all published cases of IE in kidney transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed (through 13th December 2019) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE in kidney transplant recipients was performed. A total of 60 studies, containing data of 117 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 57.4%, gram-negative microorganisms in 14.8%, fungi in 20%, while in 18.9% of cases, IE was culture-negative. Aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Diagnosis was set with a transthoracic ultrasound in half the cases, followed by transesophageal ultrasound and autopsy. Fever was present in most cases, while embolic phenomena were noted in two out of five cases. Aminoglycosides, cephalosporins and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in one out of three cases. Clinical cure was noted in 60.9%, while overall mortality was 45.3%. To conclude, this systematic review thoroughly describes IE in kidney transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes. Moreover, it identifies the emerging role of Enterococci, gram-negatives and fungi in IE in this population.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Alexakis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Spanneut TA, Paquet P, Bauters C, Modine T, Richardson M, Bonello L, Juthier F, Lemesle G. Utility and safety of coronary angiography in patients with acute infective endocarditis who required surgery. J Thorac Cardiovasc Surg 2020; 164:905-913.e19. [PMID: 33131891 DOI: 10.1016/j.jtcvs.2020.08.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the benefit/risk ratio to perform a coronary angiography (CA) before surgery for infective endocarditis (IE). METHODS We conducted a single-center prospective registry including 272 patients with acute IE intended for surgery and compared patients who underwent a preoperative CA (n = 160) with those who did not (n = 112). A meta-analysis of 3 observational studies was also conducted and included 551 patients: 342 who underwent a CA and 209 who did not. RESULTS In our registry, combined bypass surgery (CABG) was performed in 17% of the patients with preoperative CA. At 2 years, the rate of the primary composite end point (all-cause death, new systemic embolism, stroke, new hemodialysis) was similar in the CA (38%) and no-CA (37%) groups. In-hospital and 2-year individual end points were all similar between groups. There were only 2 episodes of systemic embolism after CA and only one possibly related to a vegetation dislodgement. In the meta-analysis, combined CABG was performed in 18% of the patients with preoperative CA. All-cause death was similar in both groups: odds ratio, 0.98 [0.62-1.53], P = .92. Only 5 cases of systemic embolism possibly related to a vegetation dislodgement were reported. New hemodialysis was numerically more frequent in the CA group: odds ratio, 1.68 [0.79-3.58] (18% vs 14%, P = .18). CONCLUSIONS In daily practice, two-thirds of the patients with acute IE who required surgery have a preoperative CA leading to a combined CABG in 18% of the patients. Our results suggest that to perform a preoperative CA in this context is not associated with improved prognosis.
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Affiliation(s)
- Théo-Alexandre Spanneut
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Paquet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Bauters
- Service de Cardiologie, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1067, Institut Pasteur de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France
| | - Thomas Modine
- Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marjorie Richardson
- Service d'exploration fonctionnelle cardiovasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Bonello
- Service de Cardiologie, Hopital Nord de Marseille, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Francis Juthier
- Faculté de Médecine de l'Université de Lille, Lille, France; Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
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Abbasi D, Salehi N, Faiek S, Siddiqui WJ, Ahmad S. A Ghost in Coronary Artery - Coronary Artery Embolism After Discontinuation of Rivaroxaban in a Patient With Atrial Fibrillation: Case Report and Review of Literature. Cureus 2020; 12:e10082. [PMID: 33005506 PMCID: PMC7522164 DOI: 10.7759/cureus.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronary artery embolism (CAE) is a rare clinical entity that can cause acute myocardial infarction (AMI). The exact prevalence of coronary artery embolism is unknown. CAE was found to be associated with conditions that can lead to thrombo-embolism, including infective endocarditis, atrial fibrillation, mitral valve disease, valve surgery. Herein, we report a 78-year-old male with a past medical history of atrial fibrillation on rivaroxaban who presented to the hospital emergency department complaining of chest pain. The patient's anticoagulation therapy was recently held due to a concern for gastrointestinal bleeding. After further evaluation of the patient's symptoms and reviewing his electrocardiogram (ECG) which showed ST-depression in lateral leads and ST-elevation in aVR, urgent cardiac catheterization was done which showed left main coronary artery thrombosis extending into the left anterior descending artery (LAD) and left circumflex artery (LCX). The patient was started on a heparin drip and underwent a successful aspiration thrombectomy with subsequent improvement in his symptoms.
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Affiliation(s)
- Danish Abbasi
- Cardiovascular Diseases, University of Arkansas, Little Rock, USA
| | - Negar Salehi
- Internal Medicine - Cardiology, University of Arkansas, Little Rock, USA
| | - Saif Faiek
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Waqas J Siddiqui
- Cardiology/Nephrology, Drexel University College of Medicine, Philadelphia, USA.,Cardiology/Nephrology, Orange Park Medical Center, Orange Park, USA
| | - Shahzed Ahmad
- Cardiovascular Disease, Lower Bucks Hospital, Bristol, USA
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Laperche C, Lairez O, Ferrieres J, Robin G, Gautier M, Lavie Badie Y, Lhermusier T, Boudou N, Campelo-Parada F, Roncalli J, Marcheix B, Galinier M, Elbaz M, Carrié D, Bouisset F. Coronary angiography in the setting of acute infective endocarditis requiring surgical treatment. Arch Cardiovasc Dis 2020; 113:50-58. [DOI: 10.1016/j.acvd.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023]
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7
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Zhao S, Zhu L, Tinzin L, Huang F, Ma L, Zhou Y. Acute myocardial infarction in a young woman: Unexpected findings of a coronary occlusion. Leg Med (Tokyo) 2019; 42:101662. [PMID: 31896072 DOI: 10.1016/j.legalmed.2019.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
In clinical and forensic practice, the cause of death is often attributed to acute myocardial infarction, among which the coronary atherosclerosis being the Captain of the Men of Death. However, other reasons such as coronary septic embolization with neutrophilic granulocyte myocarditis although rare, can also cause sudden unexpected death. This paper reports a case with this rare cause-a 21-year-old woman diagnosed with "acute gastroenteritis" who died 4 days later. A forensic autopsy revealed an inflammatory polypous embolic located at 1.0 cm from the left anterior descending branch (LAD) with serve neutrophilic granulocyte myocarditis, which resulted in embolic at the opening of the left main coronary artery, acute myocardial infarction and eventually leading to her death. Histopathological examination showed large amounts of neutrophilic granulocyte infiltration in the arterial layer forming the septic embolic and eventually resulting in coronary occlusion. To find the real cause of septic embolic, myocarditis, bacterial, fungal, protozoan and virus detection was performed through RT-PCR, with negative findings. Septic embolic leading coronary occlusion in left main coronary artery and LAD is rarely reported in forensic practice, we hope this report can pave the way on understanding this rare disease to make correct diagnosis in medical practice.
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Affiliation(s)
- Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longlong Zhu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Lopsong Tinzin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longda Ma
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China.
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van der Linden M, Heuts S, Veenstra L, Lorusso R. Intraoperative, open-heart coronary angiography in severe acute aortic valve endocarditis. Eur J Cardiothorac Surg 2019; 56:415-417. [PMID: 30596996 DOI: 10.1093/ejcts/ezy434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/12/2018] [Accepted: 11/17/2018] [Indexed: 12/31/2022] Open
Abstract
We present the use of intraoperative open-heart coronary angiography in a patient with aortic valve endocarditis and extensive coronary calcification on coronary computed tomography angiography. Open-heart angiography was performed intraoperatively and revealed no significant stenoses. Aortic valve replacement without concomitant bypass surgery was performed, and the patient had an uneventful postoperative course.
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Affiliation(s)
- Marcel van der Linden
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
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Subramaniam K, Serangan S, Soon LP, Feng SS. Sudden cardiac death due to coronary artery embolism secondary to native aortic valve endocarditis in a young adult. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0086-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Utility of cardiac computed tomography scanning in the diagnosis and pre-operative evaluation of patients with infective endocarditis. Int J Cardiovasc Imaging 2018; 34:1155-1163. [PMID: 29450741 DOI: 10.1007/s10554-018-1318-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/10/2018] [Indexed: 12/20/2022]
Abstract
Transesophageal echocardiography (TEE) is the gold standard imaging study used in the diagnosis of infective endocarditis (IE). Computed tomography angiography (CTA) has undergone rapid advancement as a cardiac imaging technique and has previously shown promise in small non-randomized studies for evaluation of IE. We hypothesized that cardiac CTA would perform similarly to TEE in the detection of endocarditic lesions and that there would be no difference in clinical outcomes whether the coronary arteries were evaluated by CTA or invasive coronary angiography (ICA). 255 adults who underwent surgery for IE at the Mayo Clinic Rochester between January 1, 2006 and June 1, 2014 were identified retrospectively. 251 patients underwent TEE and 34 patients underwent cardiac CTA. TEE had statistically higher detection of vegetations (95.6 vs. 70.0%, p < 0.0001) and leaflet perforations (81.3 vs. 42.9%, p = 0.02) as compared to cardiac CTA. For detection of abscess/pseudoaneurysm TEE had a similar sensitivity to cardiac CTA (90.5 vs. 78.4%, p = 0.21). There was no significant difference in peri-operative outcomes whether coronary arteries were evaluated by CTA or ICA. The greatest advantage of cardiac CT in the setting of IE is its ability to couple the detection of complex cardiac anatomic abnormalities with coronary artery delineation, serving two important components of the diagnostic evaluation, particularly among patients who will require surgical intervention due to IE complications. Cardiac CTA may be considered as an alternate coronary artery imaging modality in IE patients with low to intermediate risk of disease but meet guideline recommendations for coronary artery imaging.
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11
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Left Main Coronary Artery Thrombosis With Acute Myocardial Infarction: A Management Dilemma. Am J Med Sci 2017. [PMID: 28641723 DOI: 10.1016/j.amjms.2016.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach.
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12
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Pavani M, Conrotto F, D'Ascenzo F, D'Amico M, Centofanti P, Gaita F. Left main occlusion secondary to infective endocarditis vegetation: "The unusual suspect". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:367-368. [PMID: 28063812 DOI: 10.1016/j.carrev.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/09/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023]
Abstract
Treatment of acute coronary syndrome secondary to septic coronary embolism during valvular endocarditis is controversial. Urgent coronary angiography and stent implantation or surgical intervention have been proposed. We present the case of a patient presented at the emergency department with chest pain and cardiogenic shock. The coronary angiography showed a large filling defect in the left main due to a septic coronary embolism.
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Affiliation(s)
- Marco Pavani
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Torino, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Paolo Centofanti
- Division Of Cardiac Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Torino, Italy
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Virk HUH, Inayat F, Farooq S, Ghani AR, Mirrani GA, Athar MW. Prosthetic Aortic Valve Endocarditis with Left Main Coronary Artery Embolism: A Case Report and Review of the Literature. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:259-62. [PMID: 27500132 PMCID: PMC4960937 DOI: 10.4103/1947-2714.185040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Context: Coronary embolization is potentially a fatal sequela of endocarditis. Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is imperative to consider septic embolism as an etiological factor. Case Report: Herein, we report a case of ventricular fibrillation and ST-segment depression myocardial infarction occurring in a patient who initially presented with fever and increased urinary frequency. Coronary angiography revealed new 99% occlusion of the left main coronary artery (LMCA). Transesophageal echocardiography showed bioprosthetic aortic valve with an abscess and vegetation. Histologic examination of the embolectomy specimen confirmed the presence of thrombus and Enterococcus faecalis bacteria. Subsequently, the patient was discharged to the skilled nursing facility in a stable condition where he completed 6 weeks of intravenous ampicillin. Conclusion: We present a rare case of LMCA embolism due to prosthetic valve endocarditis. The present report also highlights the diagnostic and therapeutic challenges associated with such patients.
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Affiliation(s)
- Hafeez Ul Hassan Virk
- Department of Medicine, St. Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Salman Farooq
- Department of Neurology, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ali Raza Ghani
- Department of Medicine, Abington Jefferson Hospital, PA, USA
| | | | - Muhammed Waqas Athar
- Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Molnar A, Muresan I, Trifan C, Pop D, Sacui D. Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department - Cluj-Napoca Heart Institute. Med Pharm Rep 2015; 88:338-42. [PMID: 26609267 PMCID: PMC4632893 DOI: 10.15386/cjmed-482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 11/23/2022] Open
Abstract
Background and aims The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon. Methods We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit. Results The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was positive. In 3 cases it matched the germ identified in the hemocultures, and in 2 cases it evidenced another bacterium. Conclusion The overall mortality of 5% is well between the limits presented in literature, being higher (30%) in patients who required emergency surgery. For the patients who return into our clinic with prosthetic valve endocarditis, the mortality after surgery was even higher (50%).
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Affiliation(s)
- Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania ; Cardiovascular Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Muresan
- Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania
| | - Catalin Trifan
- Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania
| | - Dana Pop
- Cardiology Department, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Diana Sacui
- Cardiovascular Surgery Department, Heart Institute Cluj-Napoca, Romania
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15
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Multi-embolic ST-elevation Myocardial Infarction Secondary to Aortic Valve Endocarditis. Heart Lung Circ 2015; 24:e1-3. [DOI: 10.1016/j.hlc.2014.07.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 11/20/2022]
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16
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Vahdat K, Patel S, Banchs J. The short life of an aortic cusp aneurysm: a case report. Echocardiography 2014; 32:868-71. [PMID: 25409977 DOI: 10.1111/echo.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This report describes a 42-year-old man with a history of lymphoma who is admitted with symptoms of chest pain, ST elevation changes, and elevated troponins. Immediate bedside echocardiographic evaluation led to an aborted urgent coronary angiography and a diagnosis of presumed endocarditis. Transesophageal echocardiography (TTE) subsequently revealed an aortic noncoronary cusp aneurysm masking as vegetation. The rapid assessment by TTE and transesophageal echocardiogram prevented an alternate course for this patient's management. We reviewed the necessity of heart catheterization in patients with significantly elevated troponins, pericarditis symptoms, and the rare sighting of aortic valve cusp aneurysms.
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Affiliation(s)
- Khashayar Vahdat
- Department of Cardiology, University of Texas Health Science Center, Houston, Texas
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17
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Hewarathna UI, Karunaratne SP, Tennakoon R, Jayawickreme SR, Dolapihilla SNB, Mayurathan G, Kularatne AI, Attanayake PM. Septic embolization of left and right coronary arteries resulting in sudden death: A rare complication of infective endocarditis. J Cardiol Cases 2014; 10:22-24. [PMID: 30534216 DOI: 10.1016/j.jccase.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 12/21/2022] Open
Abstract
Bacterial endocarditis gives rise to a variety of complications due to local tissue damage, immunological phenomena, and embolic phenomena. Only a small number of cases of coronary embolization have been reported in infective endocarditis patients. This is a case of subacute bacterial endocarditis in a postpartum mother complicated by fatal left and right coronary artery embolization. A 32-year-old postpartum mother with a history of rheumatic heart disease presented with a history of fever, shortness of breath, and bilateral ankle edema for 1-week duration. On admission, the patient was alert, febrile with a pulse rate of 90 beats/min, blood pressure 105/70 mmHg, and her lungs were clear. Transthoracic echocardiography revealed vegetations attached to both mitral and aortic valves. She was started on intravenous antibiotics. Her fever was settled and during the following 2 weeks she was clinically improving with settling inflammatory markers. On the 20th day of the illness, the patient developed sudden onset of chest pain, dyspnea with sinus bradycardia, and later developed pulseless electric activity. She expired despite intense cardiopulmonary resuscitation. Postmortem revealed multiple vegetations in both mitral and aortic valves and complete occlusion of both left and right coronary ostia by embolized vegetative materials. <Learning objective: Subacute bacterial endocarditis with large and mobile vegetations can give rise to embolization. Although most of them cause peripheral embolization, there is a possibility of fatal coronary embolization. This case highlights the importance of early surgical intervention in bacterial endocarditis with large, multiple, and mobile vegetations even though the patient is responding to the antibiotics.>.
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18
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Açar G, Ozkok A, Dönmez C, Avcı A, Alizade E, Yanartaş M. Myocardial infarction due to septic coronary artery embolism in the course of Brucella endocarditis. Herz 2014; 40:335-7. [PMID: 24609796 DOI: 10.1007/s00059-013-4011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/24/2022]
Affiliation(s)
- G Açar
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Denizer Street, Cevizli Kavsagi, No. 2, 34846, Kartal/Istanbul, Turkey,
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19
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Sardar MR, Subrayappa N, Badri M, Khitri A, Bradley J. Coronary artery ostium occlusion--a rare manifestation of endocarditis. QJM 2013; 106:589-90. [PMID: 22696153 DOI: 10.1093/qjmed/hcs108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muhammad R Sardar
- Department of Cardiology, Lankenau Medical Center, Wynnewood, PA 19096 USA.
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20
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Courand PY, Mouly-Bertin C, Thomson V, Lantelme P. Acute coronary syndrome revealed Cardiobacterium hominis endocarditis. J Cardiovasc Med (Hagerstown) 2012; 13:216-21. [PMID: 20838281 DOI: 10.2459/jcm.0b013e32833daf81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Aortic Valve Infective Endocarditis: Could Multi-Detector CT Scan Be Proposed for Routine Screening of Concomitant Coronary Artery Disease Before Surgery? Ann Thorac Surg 2009; 87:1585-7. [DOI: 10.1016/j.athoracsur.2008.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/30/2008] [Accepted: 09/03/2008] [Indexed: 11/17/2022]
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22
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Reply to the Editor:. J Thorac Cardiovasc Surg 2009. [DOI: 10.1016/j.jtcvs.2008.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Lentini S, Tancredi F, Monaco F, Savasta M, Gaeta R. Use of coronary dual source MDCT angiography and calcium score in particular clinical settings. J Card Surg 2008; 23:797-8. [PMID: 19017019 DOI: 10.1111/j.1540-8191.2008.00752.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Kilian E, Beiras-Fernandez A, Bauerfeind D, Reichart B, Lamm P. Intraoperative coronary angiography in the management of patients with acute aortic dissection and endocarditis. J Thorac Cardiovasc Surg 2008; 136:792-3. [DOI: 10.1016/j.jtcvs.2008.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 12/28/2007] [Accepted: 01/13/2008] [Indexed: 11/26/2022]
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25
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Khan F, Khakoo R, Failinger C. Managing embolic myocardial infarction in infective endocarditis: current options. J Infect 2005; 51:e101-5. [PMID: 16230184 DOI: 10.1016/j.jinf.2004.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 10/11/2004] [Indexed: 11/21/2022]
Abstract
Systemic embolization is common in infective endocarditis and is known to occur in 45-65% of cases. Coronary artery embolism has been seen in as many as 60% of cases at necropsy. However, it only rarely has been described as resulting in transmural myocardial infarction. In most cases, coronary embolism is inferred from circumstantial evidence. We present two patients with myocardial infarction in the setting of acute infective endocarditis. Current issues regarding the management of myocardial infarction in infective endocarditis are described in this article. We also describe the first documented case of Lactobacillus jensenii endocarditis leading to myocardial infarction. Possible factors, which may be instrumental in producing endocarditis with this organism, are also discussed.
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Affiliation(s)
- Fida Khan
- Department of Internal Medicine, Section of Infectious Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA.
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26
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Gupta R, Rahman MA, Uretsky BF, Schwarz ER. Left main coronary artery thrombus: a case series with different outcomes. J Thromb Thrombolysis 2005; 19:125-31. [PMID: 16052304 DOI: 10.1007/s11239-005-1924-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup.
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Affiliation(s)
- Rajiv Gupta
- Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, 77555-0553, USA
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27
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Rigatelli G, Rigatelli G, Rossi P, Docali G. Normal angiogram in acute coronary syndromes: the underestimated role of alternative substrates of myocardial ischemia. Int J Cardiovasc Imaging 2005; 20:471-5. [PMID: 15856628 DOI: 10.1007/s10554-004-1924-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The study is aimed at evaluating the real incidence of normal coronary arteries and the role of alternative substrates of myocardial ischemia in patients with acute coronary syndrome (ACS) but with no coronary artery disease (CAD) in a real world secondary care public hospital. The medical records of 941 patients undergoing coronary arteriography for ACS within 48 h of onset between January 1st 2000 and November 1st 2003 were critically reviewed. In 70 patients (7.4%, 35 males, mean age 60 +/- 17.2 years) no CAD was documented. Alternative substrates of acute myocardial ischemia included coronary artery anomalies (7 patients, 10%), coronary spasm (10 patients, 14.3%), spontaneous coronary dissection (2 patients, 2.8%), paradoxical embolism through a patent foramen ovale (4 patients, 5.7%), embolism from left atrium or calcified aortic valve (4 patients, 5.7%), imbalance between oxygen demand and supply (20 patients, 28.5%), mitral valve prolapse (11 patients, 15.7%). No alternative substrates were found in 12 patients (17.1%). Patients with no CAD are more frequently female and younger. Absence of CAD is an uncommon finding in patients undergoing coronary artery angiography for ACS.
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28
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Rigatelli G. Normal angiogram in patients with acute coronary syndrome: searching for unusual substrates of myocardial ischemia. Int J Cardiol 2005; 99:25-7. [PMID: 15721495 DOI: 10.1016/j.ijcard.2004.03.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Accepted: 03/06/2004] [Indexed: 10/26/2022]
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29
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Abid-Allah M, Al Jubair K. Acute right coronary artery embolus after aortic valve surgery. Asian Cardiovasc Thorac Ann 2002; 10:367-8. [PMID: 12538293 DOI: 10.1177/021849230201000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 35-year-old man with rheumatic aortic valve regurgitation developed acute right ventricular failure 8 days after valve replacement with a mechanical prosthesis. Angiography showed a right coronary artery embolus. Successful coronary artery bypass grafting was performed on the beating heart.
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Affiliation(s)
- Mouhcine Abid-Allah
- Department of Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
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30
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Abstract
This report describes a case of a 31-year-old woman with mitral valve endocarditis complicated by a septic embolus to a coronary artery.
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Affiliation(s)
- Stuart Beldner
- Department of Cardiology, North Shore-Long Island Jewish Health Care System, Manhasset, New York, USA
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