Coronary Artery Embolism from Large Aortic Valve Vegetation due to Staphylococcus aureus Endocarditis

Journal of General Internal Medicine, May 2017

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs11606-016-3935-4.pdf

Coronary Artery Embolism from Large Aortic Valve Vegetation due to Staphylococcus aureus Endocarditis

Coronary Artery Embolism from Large Aortic Valve Vegetation due to Staphylococcus aureus Endocarditis Aman M. Shah 1 3 Ricardo A. Bello 1 2 Benjamin T. Galen ) 0 1 0 Department of Internal 1 Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Division of Hospital Medicine , Bronx, NY , USA 2 Heart and Vascular Center, University of Massachusetts Memorial Medical Center , Worcester, MA , USA 3 Department of Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Division of Cardiovascular Medicine , Bronx Compliance with Ethical Standards: - 46-year-old man with a history of intravenous drug use presented with 5 days of fever as high as 102°F. He was ill-appearing, tachycardic, and without a heart murmur. Labs revealed marked leukocytosis and elevated troponin-T to 1.31 ng/ml (0.00–0.10 ng/ml), and blood cultures grew methicillinsusceptible Staphylococcus aureus 12 h after collection. Transthoracic echocardiogram showed a 4-cm mobile vegetation on the aortic valve. Troponin-T peaked the next day at 4.83 ng/ml, and while he remained free of chest pain, EKG revealed new ST-segment elevations in the anterolateral leads concerning for an acute coronary syndrome. Coronary angiogram identified 100% occlusion of both the distal left anterior descending artery (LAD) and the second diagonal branch of the LAD, consistent with coronary artery emboli (Fig. 1). The Figure 1 Coronary angiography with distal LAD (red arrow) and second diagonal branch total occlusions (black arrow). Figure 2 Aortic valve vegetations (red arrows) and perforation (black arrow). patient underwent aortic valve replacement and a one-vessel LAD bypass. A perforated aortic valve leaflet and multiple vegetations were seen on gross examination (Fig. 2). He was treated with intravenous cefazolin for 4 weeks. The complications of left-sided endocarditis can be fatal. Surgery may be required in cases of persistent bacteremia or septic embolization.1 Embolism of a vegetation to the coronary arteries is rare. Treatment options include thrombectomy, angioplasty with stenting, and bypass surgery.2,3 Conflict of Interest: The authors declare that they have no conflict of interest and have no financial disclosures to report. 1. Baddour LM , Wilson WR , Bayer AS , et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association . Circulation. 2015 ; 132 : 1435 - 86 . 2. Glazier JJ , McGinnity JG , Spears JR . Coronary embolism complicating aortic valve endocarditis: treatment with placement of an intracoronary stent . Clin Cardiol . 1997 ; 20 ( 10 ): 885 - 8 . 3. Maqsood K , Sarwar N , Efekhari H , Lotfi A. Septic coronary artery embolism treated with aspiration thrombectomy: case report and review of literature . Tex Heart Inst J . 2014 ; 41 ( 4 ): 437 - 9 .


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs11606-016-3935-4.pdf

Coronary Artery Embolism from Large Aortic Valve Vegetation due to Staphylococcus aureus Endocarditis, Journal of General Internal Medicine, 2017, DOI: 10.1007/s11606-016-3935-4