Septic coronary embolism treated with manual aspiration thrombectomy

Abstract

Abstract Rationale: Systemic embolism is a known complication of infective endocarditis (IE), but it rarely presents as acute myocardial infarction (AMI). Aspiration thrombectomy without stenting is a possible approach in this context. The authors present a rare case of coronary embolism caused by Aggregatibacter aphrophilus IE successfully treated with manual aspiration thrombectomy. Patient concerns: A 19-year-old man with previous valve disease was admitted to the emergency department with fever and dyspnea. The next day, the patient presented with chest pain and hemodynamic instability. Diagnosis: Transesophageal echocardiography confirmed the presence of infectious endocarditis at the mitro-aortic junction. Blood cultures identified Aggregatibacter aphrophilus. Electrocardiogram showed significant ST segment elevation in leads V1 to V5, indicating AMI. Coronary angiography revealed total occlusion of the left anterior descending artery. The histopathological examination of the material aspirated from the coronary artery showed fibrin thrombi containing gram-negative cocci. Interventions: Manual aspiration thrombectomy was performed without stent implantation. No antithrombotic therapy was needed during and post-procedure. After clinical stabilization, the patient underwent cardiac surgery. Outcomes: Transesophageal echocardiogram before discharge showed preserved left ventricular function, with no segmental left ventricular wall motion abnormalities, and the aortic metal prosthesis without dysfunction. After discharge, a new transesophageal echocardiogram was performed with 1 month of follow-up. No evidence of recurrence of IE was found in the first postoperative review and the patient remained stable. Lessons: Manual aspiration thrombectomy without stenting and antithrombin therapy is feasible in patients with AMI due to IE.