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Myocardial ischaemia as a result of external coronary compression from infective aortic root aneurysm: atypical presentation of prosthetic valve endocarditis
Echo Research & Practice volume 5, pages K35–K40 (2018)
Summary
This case describes an unusual presentation of prosthetic valve endocarditis (PVE): an acute coronary syndrome. A 67-year-old male presented with cardiac sounding chest pain on a background of a short history of night sweats, weight loss and general malaise. Four months previously, he had undergone bio-prosthetic aortic valve replacement for severe aortic stenosis and single vessel bypass grafting of the obtuse marginal. Whilst having chest pain, his ECG showed infero-lateral ST depression. Early coronary angiography revealed a new right coronary artery (RCA) lesion that was not present prior to his cardiac surgery. Using multi-modality cardiac imaging, the diagnosis of PVE was made. An aortic root abscess was demonstrated that was causing external compression of the RCA.
References
Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL. Trends in infective endocarditis incidence, microbiology, and valve replacement in the united states from 2000 to 2011. Journal of the American College of Cardiology 2015 65 2070–2076. (https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2015.03.518)
Habib G, Lancellotti O, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European Heart Journal 2015 36 3075–3128. (https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehv319)
Murtaza G, Rahman ZU, Sitwala P, Ladia V, Barad B, Albalbissi K, Paul TK, Ramu V. Case of acute ST segment elevation myocardial infarction in infective endocarditis–management with intra coronary stenting. Clinics and Practice 2017 7 950. (https://doiorg.publicaciones.saludcastillayleon.es/10.4081/cp.2017.950)
Clarke NR, Forfar JC. Aortic root abscess presenting as unstable angina due to extrinsic compression of the left coronary artery. Postgraduate Medical Journal 2002 78 168–169. (https://doiorg.publicaciones.saludcastillayleon.es/10.1136/pmj.78.917.168)
Harinstein ME, Marroquin OC. External coronary artery compression due to prosthetic valve bacterial endocarditis. Catheterization and Cardiovascular Interventions 2014 83 E168–E170. (https://doiorg.publicaciones.saludcastillayleon.es/10.1002/ccd.24578)
Parashara DK, Jacobs LE, Kotler MN, Yazdanfar S, Spielman SR, Janzer SF, Bemis CE. Angina caused by systolic compression of the left coronary artery as a result of pseudo aneurysm of the mitral-aortic intervalvular fibrosa. American Heart Journal 1995 129 417–421. (https://doiorg.publicaciones.saludcastillayleon.es/10.1016/0002-8703(95)90031-4)
Rogers JG, McManus BM, Cassling RS, Dobry CA, Fleming WH. False aneurysm of the aortic root: mimic of malignancy, mediator of myocardial ischaemia. American Heart Journal 1987 113 1237–1239. (https://doiorg.publicaciones.saludcastillayleon.es/10.1016/0002-8703(87)90944-6)
Fabri J Jr, Issa VS, Pomerantzeff PM, Grinberg M, Barretto AC, Mansur AJ. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. International Journal of Cardiology 2006 110 334–339. (https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ijcard.2005.07.016)
Singh M, Mishra A, Kaluski E. Acute ST-elevation myocardial infarction due to septic embolism: a case report and review of management options. Catheterization and Cardiovascular Interventions 2015 85 E166–E171. (https://doiorg.publicaciones.saludcastillayleon.es/10.1002/ccd.25829)
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Sekar, B., Wheeler, R., Masani, N. et al. Myocardial ischaemia as a result of external coronary compression from infective aortic root aneurysm: atypical presentation of prosthetic valve endocarditis. Echo Res Pract 5, K35–K40 (2018). https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-18-0022
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DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-18-0022