Author + information
- Received August 7, 2017
- Accepted August 29, 2017
- Published online January 1, 2018.
- Ioannis Tsiafoutis, MD, PhD,
- Panagiotis Koudounis, MD, MSc,
- Michael Koutouzis, MD, PhD and
- Theodoros Zografos, MD, MSc, PhD∗ ()
- ↵∗Address for correspondence:
Dr. Theodoros Zografos, 1st Cardiology Department, Athens Red Cross Hospital, 1 Athanasaki Street, 11521 Athens, Greece.
A 55-year-old woman with ongoing myocardial infarction was referred to our hospital for coronary angiography. She had presented to her local hospital with low-grade fever that started 72 h before and then developed aphasia and anterolateral ST-segment elevation (Figure 1A). An urgent computed tomography brain scan revealed an acute left temporal ischemic stroke with petechial hemorrhage, whereas a bedside transthoracic echocardiogram revealed anterolateral wall hypokinesia of the left ventricle and a nonmobile, 10-mm mass attached to the aortic surface of the aortic valve (Figure 1B, Online Videos 1, 2, 3, and 4), with no significant aortic regurgitation. The patient underwent a coronary angiogram, which revealed a thrombus in left circumflex coronary artery (Figure 1C1, Online Video 5). We performed thrombus aspiration with a good angiographic result (Figure 1C2, Online Video 6), nevertheless, due to a high index of suspicion for endocarditis, the thrombus (Figure 1D) was sent for histopathological examination (Figure 1E). The thrombus consisted of neutrophils, extracellular cocci with appearance typical for Staphylococcus (Figure 1E, open arrows), as well as neutrophils with phagocytosed Staphylococcus (Figure 1E, solid arrows). According to current diagnostic criteria, a definite diagnosis for infective endocarditis was made and the patient was started on antibiotics. Three days later the patient developed refractory pulmonary edema requiring intubation. A bedside transesophageal echocardiogram revealed a huge vegetation causing disruption of aortic valve with concomitant torrential regurgitation (Figure 1F, Online Video 7). The patient was referred for emergent cardiothoracic evaluation but unfortunately died before the scheduled operation. This case suggests that aspiration thrombectomy presents a rare opportunity for histopathological examination of thrombotic material, which should be always used in ambiguous cases.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2017.
- Accepted August 29, 2017.
- 2018 American College of Cardiology Foundation