Primary percutaneous coronary intervention during ST elevation myocardial infarction in prosthetic valve endocarditis: A case report

Alfonso Campanile, Guido Tavazzi, Francesco Caprioglio, Fausto Rigo

Research output: Contribution to journalArticle

Abstract

Background: Infective endocarditis (IE) is still a condition with high mortality and morbidity, especially in the elderly, and in patients with prosthetic valves. The concept of "time-to-therapy" plays a key role for the prompt management of IE and related complications, and the currently available multimodality imaging may play a key role in this setting. Myocardial ischemia due to extrinsic coronary compression from an aortic abscess is an extremely rare condition where the optimal therapeutic strategy has not been defined yet. We present herein the first case of a patient with ST elevation myocardial infarction caused by an aortic root abscess treated with percutaneous stent implantation. Case presentation: An 82-year-old woman with a history of atrial fibrillation, chronic renal failure, anemia and a bioprosthetic aortic valve replacement performed in 2014, was admitted to hospital with profound asthenia and a pyrexia of unknown origin. Because of high clinical suspicion of endocarditis, a trans-esophageal echocardiogram was performed. Empirical broad-spectrum antimicrobial therapy was initiated, followed by targeted treatment based on the results of blood cultures (Staphylococcus aureus). The echocardiogram did not show vegetations and the patient was managed conservatively. She suddenly deteriorated, due to an acute coronary syndrome (ACS) with anterior ST segment elevation. An urgent angiogram was performed, and extrinsic compression of the left coronary system, due to an aortic root abscess, was suspected. After discussion with the surgical team, percutaneous revascularization was attempted, aiming to restore satisfactory hemodynamics, in order to plan surgery. Unfortunately, the patient rapidly developed cardiogenic shock, with multi organ failure, and died in less than 24 h. Conclusions: Patients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography. At present, the specific timing of echocardiographic follow-up and surgical intervention is still a matter of debate, and our case aims to highlight the importance of this aspect in the management of endocarditis, in order to avoid severe complications that adversely affect patient prognosis.

Original languageEnglish
Article number28
JournalBMC Cardiovascular Disorders
Volume18
Issue number1
DOIs
Publication statusPublished - Feb 9 2018

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Percutaneous Coronary Intervention
Endocarditis
Abscess
Acute Coronary Syndrome
Fever
Play Therapy
Asthenia
Cardiogenic Shock
Aortic Valve
Atrial Fibrillation
Chronic Kidney Failure
Stents
Myocardial Ischemia
Echocardiography
Staphylococcus aureus
ST Elevation Myocardial Infarction
Anemia
Angiography
Therapeutics
Hemodynamics

Keywords

  • AMI
  • Elderly patients
  • Endocarditis
  • PPCI
  • TTE/TEE

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Primary percutaneous coronary intervention during ST elevation myocardial infarction in prosthetic valve endocarditis : A case report. / Campanile, Alfonso; Tavazzi, Guido; Caprioglio, Francesco; Rigo, Fausto.

In: BMC Cardiovascular Disorders, Vol. 18, No. 1, 28, 09.02.2018.

Research output: Contribution to journalArticle

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