Infected ("Mycotic") coronary artery aneurysm: Systematic review.

BACKGROUND: Infected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection. METHODS: A retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed. RESULTS: 83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%). CONCLUSION: ICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.

Coronary stent infections: a case series.

Stent infection is a rare sequela of coronary stent implantation first reported fifteen years ago. Since that time, much has been learned about this dramatic disease entity by way of case report and review. Nevertheless, clinical experience with regard to the diagnosis and management of coronary artery stent infection remains limited. Here, we report 3 cases of coronary stent infections; 2 with mycotic aneurysms (seen on coronary angiography) that ruptured into an adjacent cardiac chamber, and one with purulent pericarditis. The microbiology as well as the possible mechanisms and risk factors for these infections are discussed.

Mycotic coronary aneurysms.

: Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.

Implantation of multiple polytetrafluoroethylene covered stent inside drug eluting stent to rescue purulent coronary artery ectasia with giant saccular aneurysm.

A 79-year-old male with diabetes mellitus and old cerebral infarction was admitted to hospital due to fever and palpitation. Diagnosis of purulent pericarditis was established by pericardial effusion examination. The patient's general condition improved temporarily after drainage of the pericardial effusion. However, computed tomography demonstrated a saccular aneurysm arising from RCA have rapidly grown even larger, up to 63 × 51 mm on 7th hospital day. This indicated that the risk of rupture of the aneurysm was high. Percutaneous coronary intervention was applied to prevent rupture of the aneurysm. Several polytetrafluoroethylene (PTFE)-covered stents were required to cover the extended aneurysm lesion. A long drug-eluting stent (DES), which was initially implanted through the aneurysm, was itself implanted with 3 PTFE-covered stents located inside the DES. This procedure provided protection against endoleak of the aneurysm. To our knowledge, the present case shows for the first time that PTFE-covered stents located within DES are useful in treatment of a giant coronary aneurysm.

Infective coronary aneurysms: a complication of percutaneous coronary intervention.

We present the case of a patient who developed infective coronary artery aneurysms after percutaneous coronary artery intervention. We describe the patient's clinical presentation, diagnosis, and treatment, and we review the pertinent medical literature.

Fatal rupture of a mycotic aneurysm of the right coronary artery post pneumococcal sepsis.

Aneurysms of the coronary arteries are rare and mycotic coronary aneurysms are even rarer. We report a unique, yet unfortunately autopsy-proven fatal case of a ruptured atherosclerotic mycotic aneurysm of the right coronary artery with streptococcus pneumoniae in a non-immunocompromised patient resulting in cor tamponade and death.

Left Anterior Descending Coronary Artery and Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report.

The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M. Bovis mycotic aneurysms as a late complication of intravesicular BCG therapy for superficial bladder cancer. The patient initially presented with acute onset pain and swelling in the left knee > 2 years following initial therapy, and initial workup revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment and additional workup, the patient was discovered to have additional aneurysms in the right popliteal artery and left anterior descending artery (LAD). Surgical pathology and bacterial cultures obtained from the excised femoral aneurysms and surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm.

Coronary artery bypass graft mycotic aneurysms in a dialysis patient.

Infection is a common problem in dialysis patients and ranks second behind cardiovascular disease as a major cause of death. The major causes of infections, mainly bloodstream infections, often are related to dialysis access. Metastatic infectious complications have been reported frequently in the course of such bacteremias. We report the case of a 79-year-old dialysis patient who was admitted with recurrent catheter-related bacteremia caused by methicillin-resistant Staphylococcus aureus. Echocardiography and a computed tomographic scan of her chest showed multiple coronary artery bypass graft mycotic aneurysms. Despite prompt dialysis catheter removal and antibiotic treatment, she had progressive deterioration of her hemodynamic and mental status and eventually died of profound sepsis. An autopsy confirmed computed tomographic findings, plus extensive suppuration involving the left atrial and ventricular myocardium and upper lobe of the left lung. To our knowledge, this is the first report of coronary artery graft aneurysms complicating infective endocarditis in a dialysis patient.

Contained rupture of mycotic aneurysm of the left circumflex coronary artery in a child.

Coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery segment to a diameter of more than 1.5-fold normal size. Rupture of CAA is a catastrophic event and may result in sudden death or myocardial infarction. We report this unusual case of contained rupture of the left circumflex CAA.

Successful treatment of a ruptured mycotic coronary artery aneurysm.

Documented mycotic aneurysms of the coronary arteries are unusual, and antemortem identification of such an aneurysm is rare. We present the case of a patient who had successful management of a ruptured mycotic aneurysm of a coronary artery.

[Mycotic aneurysm of the coronary artery]. / Mykotické aneuryzma koronární arterie.

Mycotic aneurysm of the coronary artery occurs in less than 1% of patients with infective endocarditis and only few cases of successful treatment has been described in the literature. The paper presents a case of 64 years old man with infective endocarditis of the mitral valve, complicated with a development of mycotic aneurysm of the right coronary artery, who was successfully surgically treated.

Successful surgical outcome of infected aneurysmal drug-coated stent endocarditis.

A 52-year-old man developed pyrexia after primary angioplasty following anterior myocardial infarction Noninvasive evaluation revealed staphylococcal septicemia with suspicion of an aneurysm or abscess at the stented segment. Coronary angiography confirmed the presence of a large aneurysm. The infected left anterior descending artery aneurysm was de-roofed and ligated, and a saphenous vein bypass graft was placed, with an excellent outcome.

Mycotic left main coronary artery aneurysm following double-valve replacement for active infective endocarditis.

A 68-year-old man underwent double-valve replacement (DVR) for active infective endocarditis caused by Enterococcus faecalis. Postoperative coronary angiography (CAG) revealed a saccular aneurysm originating from the distal portion of LMCA with severe stenosis at the ostium of the left anterior descending (LAD) artery and left circumflex artery (LCx). Emergent surgical resection with concomitant coronary artery bypass grafting were performed.Mycotic coronary artery aneurysms have a great tendency to rupture, and this may result in cardiac tamponade and sudden death. Early recognition and prompt surgical intervention is mandatory to minimize those fatal complications.

Mycotic coronary aneurysm: report of two cases.

The number of percutaneous interventions with stent implantation has increased dramatically in recent years, although the frequent use of this device in reports of infections is extremely rare. In this article we report two cases of mycotic aneurysm after implantation of stents with different clinical presentations and outcomes.