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Greif S, Bernas M, Cogan J, Ghani OA. Case of Mycotic Coronary Aneurysm Treated with Percutaneous Coil Embolization. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:291-294. [PMID: 34877540 PMCID: PMC8646862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mycotic coronary aneurysms are rare, with potentially fatal complications. The treatment of choice is surgical intervention. We present a case of a mycotic coronary aneurysm secondary to a catheter-related bloodstream infection, failed surgical treatment, and eventual treatment with percutaneous coil embolization.
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Affiliation(s)
- Shana Greif
- Cardiovascular Disease Fellowship Program, John A. Burns School of Medicine, University of Hawai‘i (SG)
| | - Monika Bernas
- Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai‘i (MB)
| | - John Cogan
- Interventional Cardiology, The Queen’s Medical Center, Honolulu, HI (JC)
| | - Omar Abdul Ghani
- Cardiovascular Disease, The Queen’s Medical Center, Honolulu, HI (AG)
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Mansour MJ, Mansourati V, Richard M, Al Ayouby A, Mansourati J, Gilard M, Jobic Y. Multimodality Imaging of a Very Large Mycotic Aneurysm of the Right Coronary Artery. Circ Cardiovasc Imaging 2021; 14:e011327. [PMID: 33504159 DOI: 10.1161/circimaging.120.011327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamad Jihad Mansour
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Division of Cardiology, Lebanese University, Faculty of Medical Sciences, Lebanon (M.J.M.)
| | - Vincent Mansourati
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
| | - Matthias Richard
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
| | - Ahmad Al Ayouby
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
| | - Yannick Jobic
- Department of Cardiology, University Hospital of Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.).,Université de Bretagne Occidentale, Brest, France (M.J.M., V.M., M.R., A.A.A., J.M., M.G., Y.J.)
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Ray M, McGee M, Collins N, Cooke H. Rapidly expanding saphenous vein graft myoctic aneurysm causing ST-elevation myocardial infarction: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32352057 PMCID: PMC7180533 DOI: 10.1093/ehjcr/ytaa021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/23/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022]
Abstract
Background Mycotic aneurysms of coronary vein grafts are rare and associated with high mortality. They are most commonly a result of surgical or percutaneous intervention, and present with complications including myocardial infarction (MI), infective endocarditis. A recent literature review identified 97 cases of mycotic coronary aneurysms in total. Case summary A 49-year-old man with a history of coronary artery bypass grafting and septic arthrithis presented with chest pain and fevers and ST elevation on electrocardiogram. Urgent angiogram showed an aneurysmal saphenous vein graft from the PL branch to PDA-no acute intervention was performed due to concern about bacteraemia. Methicillin-sensitive Staphylococcus aureus was grown in urine and blood but no focus of infection was identified. Despite treatment with antibiotics and antiplatelets, the patient returned with evidence of expansion of the SVG aneurysm requiring surgical resection. Discussion This case highlights the difficulty in treating acute coronary syndromes involving mycotic aneurysms. Multimodal imaging approaches are useful to identify suspected infection, but false negatives occur. Due to high risk of rupture or haemorrhage, there are limited options for urgent reperfusion in cases of MI with mycotic aneurysm, demonstrating the need for an individualized approach and close follow-up.
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Affiliation(s)
- Max Ray
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle 2305, New South Wales, Australia
| | - Michael McGee
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle 2305, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle 2305, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Heather Cooke
- Cardiovascular Department, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle 2305, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
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Ali U, Stamp N, Larbalestier R. Resection of a large mycotic aneurysm of the left anterior descending coronary artery. BMJ Case Rep 2019; 12:12/12/e232894. [PMID: 31818900 DOI: 10.1136/bcr-2019-232894] [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] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive S taphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.
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Affiliation(s)
- Umar Ali
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Nikki Stamp
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Haque H, Zohourian H. Outcome of a giant coronary artery mycotic pseudoaneurysm secondary to non-typhoid Salmonella managed without surgical intervention. BMJ Case Rep 2019. [DOI: 10.1136/bcr-2018-227104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 48-year-old woman with a history of AIDS, a recent coronary artery bypass graft operation and prior bacteraemia with non-typhoid Salmonella presented with non-exertional chest pain and elevated troponins. The cardiac catheterisation and coronary CT angiography revealed a 9 cm pseudoaneurysm arising from the proximal left anterior descending artery. The blood cultures confirmed non-typhoid Salmonella. Emergent surgery was initially deferred due to her complex anatomy. Moreover, the hospital course was complicated by Epstein-Barr virus meningitis and an associated decline in the patient’s mentation. Consequently, the mycotic pseudoaneurysm was medically managed with antibiotics and strict blood pressure goals. The natural history of giant mycotic coronary artery pseudoaneurysm formation and progression is appreciated through this first reported medically managed case. The follow-up coronary CT angiography at 3 months showed evidence of pseudoaneurysm leakage into surrounding tissue. The patient expired at 5 months from an unknown cause.
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