Author + information
- Received October 27, 2016
- Accepted November 3, 2016
- Published online February 6, 2017.
- Nobuaki Kobayashi, MD, PhDa,∗ (, )
- Yusaku Shibata, MDa,
- Noritake Hata, MD, PhDa and
- Wataru Shimizu, MD, PhDb
- aDivision of Invasive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- bDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Nobuaki Kobayashi, Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan.
A 68-year-old man, who underwent aortic valve replacement (biological valve, Carpentier-Edwards PERIMOUNT Magna Aortic Bioprosthesis 21 mm, Edwards Lifesciences, Irvine, California) for aortic valve regurgitation without coronary artery disease 5 months previous, was admitted to our institution due to prolonged fever. Fifteen hours after admission, he suddenly experienced severe chest pain with ST-segment elevation in the lateral and aVR leads. Emergency coronary angiography (CAG) showed a contrast medium filling defect for the left main trunk (LMT), the proximal left anterior descending coronary artery (LAD), the ostial left circumflex coronary artery (LCX), and the ramus intermedius artery (RA) (Figure 1, Online Video 1). Due to insufficient intracoronary aspiration, a stent was implanted at the LMT and proximal LAD. After using the kissing balloon technique for the LAD and LCX, acceptable coronary flow for the LAD and LCX was obtained, although the RA was occluded (Figures 2A and 2B, Online Videos 2 and 3). On the basis of the Duke criteria (i.e., more than 2 positive blood cultures [Staphylococcus epidermidis], predisposing heart condition, fever, and major arterial embolism), he was diagnosed with prosthetic valve endocarditis and subsequent myocardial infarction due to coronary artery septic embolism. The infection was controlled by intravenous vancomycin administration for more than 2 months. CAG performed 1 year later showed a giant aneurysm with coronary flow disturbance in the RA and a small aneurysm in the LMT (Figures 2C and 2D, Online Videos 4 and 5). Repeated CAG performed after 5 years of careful clinical follow-up showed that the giant coronary artery disappeared in association with the RA occlusion, and the small aneurysm in the LMT remained unchanged (Figures 2E and 2F, Online Videos 6 and 7).
Although some reports have previously described coronary embolization due to infectious endocarditis (1–4), none showed aneurysm formation in the culprit coronary artery during follow-up. The possible mechanism responsible for the aneurysm formation was infectious embolism. In the current case, long-term angiographic follow-up demonstrated that the infectious aneurysms did not deteriorate.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2016.
- Accepted November 3, 2016.
- American College of Cardiology Foundation