Infective endarteritis of coronaries following percutaneous coronary intervention (stentocarditis) leading to pseudoaneurysm - a retrospective study of eleven cases.

Background: Coronary endarteritis and stent abscess following percutaneous coronary intervention (PCI) are rare and challenging conditions with no clear treatment guidelines available. Aims: This retrospective study aims to present the clinical features, patient and procedural factors, management strategies, and outcomes in 11 consecutive cases referred between 2018 and 2022. Methods: We retrospectively analysed 11 cases of coronary endarteritis and stent abscess post-PCI that were referred from various centres. We recorded clinical features, patient demographics, procedural factors, and management approaches, and evaluated treatment outcomes. Results: Among the 11 patients, 7 (63.6%) were male. PCIs had been performed in the right coronary artery (6, 54.5%), left anterior descending artery (3, 27.3%), and circumflex artery (2, 18.2%). The presenting symptoms included fever, pericarditis with effusion, tamponade, and postinterventional angina due to stent occlusion. Fever occurred in 10 (90.9%) patients, and the majority (70%) of patients experienced fever within one week of PCI. Staphylococcus aureus was the predominant organism (54.5%), followed by Pseudomonas aeruginosa. Transthoracic echocardiography revealed abscess cavities in 10 patients. All patients received vancomycin and piperacillin-tazobactam. Surgery was considered in 7 cases with abscesses >2 cm; one patient refused and responded to antibiotics for 4 weeks. Possible risk factors included repeated use of local sites, reuse of hardware, multiple guidewire manipulations, prolonged catheterisation, inadequate sterility, and diabetes. Conclusions: This study provides insights into coronary endarteritis and stent abscess following PCI. The lack of clear treatment guidelines highlights the challenges in managing this condition. Identifying risk factors may aid in preventive strategies. Further research is needed to develop standardised approaches for effective management.

Malignant arrhythmia with benign tumour: fibrolipoma of the left ventricle.

We report a case of young male referred for evaluation of recent onset recurrent syncope. Inhospital electrocardiogram revealed an episode of ventricular flutter which reverted spontaneously to sinus rhythm. Transthoracic echocardiogram showed hyperechoic mass in the left ventricle. For further tissue characterization a cardiac magnetic resonance imaging was done which revealed a left ventricular mass with predominant fat content. The tumor was surgically resected. Histopathological examination confirmed the diagnosis of cardiac fibrolipoma. The patient recovered and is currently asymptomatic.

Multiple ventricular septal rupture after blunt trauma.

Ventricular septal rupture occurring as a result of blunt trauma is a very rare clinical condition. Compression of the heart between the sternum and the vertebral column during late diastole or isovolumetric contraction resulting in sudden increase in the intracardiac pressure is a prerequisite for its occurrence. Sudden relief of the inner pressure becomes impossible when the heart is full, thereby resulting in myocardial contusion and rupture. We report a case of a young schoolboy who presented to us with this serious disease and was successfully treated with surgical closure of the defect with a polytetrafluoroethylene patch.