IMR Press / RCM / Volume 20 / Issue 1 / DOI: 10.31083/j.rcm.2019.01.4241
Open Access Case Report
Infective Endocarditis complicated with Coronary Artery Septic Embolization: Is It Worth to Be Mentioned? Case Presentation and Review of the Literature
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1 Faculty of Medicine, Second Department of Medicine and Cardiology Center, Department of Cardiac Surgery, Albert Szent-Györgyi Clinical Centre, University of Szeged, 8 Semmelweis Str 6725 Szeged, Hungary
2 Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Albert Szent-Györgyi Clinical Centre, University of Szeged, 8 Semmelweis Str 6725 Szeged, Hungary
3 Faculty of Medicine, Second Department of Medicine and Cardiology Center, Department of Cardiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, 8 Semmelweis Str 6725 Szeged, Hungary
4 Faculty of Medicine, Second Department of Medicine and Cardiology Center, Department of Interventional Cardiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, 8 Semmelweis Str 6725 Szeged, Hungary
Rev. Cardiovasc. Med. 2019, 20(1), 35–39; https://doi.org/10.31083/j.rcm.2019.01.4241
Published: 30 March 2019
Abstract

Coronary artery septic embolization is a rare, but severe complication of infective endocarditis involving the leftside of the valves. The first case mentioned in the literature was a postmortem finding of a left anterior descending coronary artery occlusion by a vegetation fragment. Since this case, there have been several therapeutic strategies published with this clinical setting including medical treatment, percutaneous coronary angioplasty addressing coronary occlusion, surgical intervention for both the infected valve and coronary embolization, and hybrid procedures with transcatheter septic embolus aspiration followed by surgical valvular interventions. Out of the three interventions mentioned, the latter provided the best results and was in concordance with results observed in a case of mitral valve infected endocarditis complicated with acute occlusion of the left anterior descending coronary artery in patient whose comorbidities included hypertrophic obstructive cardiomyopathy. A transcatheter left anterior descending coronary artery embolus aspiration was performed , followed by a surgical mitral valve replacement and septal myectomy with an uneventful postoperative course. Although rare, this severe complication of infective endocarditis has a specific clinical course and therapeutic strategy, and in our opinion, it could be mentioned as a separate entity among embolic complications of infective endocarditis in future guidelines. Previously published cases suggest that the hybrid intervention might be the therapy of choice for this clinical setting; however, larger studies are necessary for confirmation.

Keywords
Coronary artery septic embolization
infective endocarditis
hybrid approach
infective endocarditis guidelines
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