Coronary embolism: surgical management

A Ghost in Coronary Artery - Coronary Artery Embolism After Discontinuation of Rivaroxaban in a Patient With Atrial Fibrillation: Case Report and Review of Literature

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.

Acute right coronary artery embolus after aortic valve surgery

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.

Coronary artery saddle embolus and myocardial infarction in a patient with prosthetic mitral valve

Coronary embolism is a rare cause of transmural myocardial infarction. A 58-year old female with mechanical mitral valve prosthesis and chronic atrial fibrillation who presented with anterolateral myocardial infraction is described. The etiologies, diagnosis, treatment dilemma and various management options are discussed.

Diagnosis of coronary artery atheroembolism by right ventricular endomyocardial biopsy

A case of coronary artery atheroembolism in a 54-year-old man, presenting as worsening congestive heart failure 2 months after mitral valve repair, left ventricular aneurysmectomy, and coronary artery bypass grafting, is reported. The diagnosis was made by right ventricular endomyocardial biopsy. The authors believe this to be the first such account in the literature.

Spontaneous pneumothorax

Spontaneous pneumothorax is not uncommon and can be potentially dangerous, especially in older people. A series of 201 patients is presented. Conservative treatment with tube thoracostomy had a 19% failure rate. It seems nevertheless to be the treatment of choice, though with risk of serious complications. Among the 60 patients who underwent lateral thoracotomy, 30% had recurrence of pneumothorax or other complications. Reoperation because of inadequate pulmonary expansion was necessary in four cases.