Coronary Artery Complications in Infective Endocarditis

Abstract

a v O FE A T U R E A R T IC LE S 52-year-old man with a prior bioprosthetic aortic valve replacement (Carpentier-Edwards valve; Edwards ifesciences, Irvine, CA) for Staphylococcus aureus endocaritis 2 years earlier was admitted with sudden onset of ever, headache, vomiting, and confusion. Blood cultures ere positive for S aureus. He was transferred to University of Ottawa Heart Instiute 9 days later because of a persistent fever despite ntibiotic therapy and new-onset chest pain associated with iffuse ST segment depression on the day of transfer. On resentation, he was in respiratory distress, his heart rate as 130 beats/min, and his blood pressure was 95/38 mm Hg. echanical ventilation and inotropic support were initiated. An urgent transesophageal echocardiogram (TEE) demnstrated multiple vegetations on the aortic bioprosthesis ausing severe stenosis but no insufficiency. A periaortic bscess (Fig 1A, arrowheads) extended laterally and comressed the left main coronary artery (arrow). Pulsed wave oppler (Fig 1B) showed high velocity coronary flow conistent with significant stenosis. The right coronary artery as aneurysmally dilated. There was severe left ventricular ystolic dysfunction with akinesis of the anterior wall. The atient was assessed for emergency aortic valve surgery, ut his condition deteriorated rapidly and he died within 12 ours of onset of chest pain. Autopsy confirmed the TEE findings. There were multiple egetations on the aortic bioprosthesis, extensive abscess foration of the periaortic area, and an aneurysmally dilated ight coronary artery (Fig 2A) with saccular mycotic aneuysms demonstrated in multiple transverse sections (Fig 2B). Coronary artery involvement with infective endocarditis an occur by several mechanisms. Aortic root abscess can ead to extrinsic compression and distortion. Coronary