Intravascular Ultrasound Findings of BioGlue Surgical Adhesive Coronary Embolism After Ascending Aorta Replacement

Yokoi, Masashi; Fujita, Hiroshi; Ogawa, Tatsuhito; Ito, Tetsuhide; Seo, Yoshihiro; Suda, Hisao; Ohte, Nobuyuki

doi:10.1016/j.jcin.2020.11.018

Cited by 1 publication

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“…In some cases, the aetiology of coronary events is unclear, and IVUS and/or OCT images can be helpful for further investigation. 9 According to the present study and previous reports, BioGlue is visualized as a mass with no or less echogenicity by IVUS, 5 , 6 which might be confusing with thrombi. Optical coherence tomography can clearly distinguish BioGlue from thrombi.…”

Section: Discussionsupporting

confidence: 73%

“…Although the embolic material could not be aspirated, the IVUS findings were consistent with those reported in previous cases of BioGlue embolism. 5 , 6 The OCT findings were also suggestive of inorganic material. Furthermore, the in vitro study demonstrated that the in vivo OCT image of the embolus was quite similar to BioGlue.…”

Section: Discussionmentioning

confidence: 97%

“…To the best of our knowledge, there are six previous reports of coronary embolism due to BioGlue, including suspected cases. One case was diagnosed by autopsy, 3 one by pathology, 4 two by both pathology and IVUS, 5 , 6 and two were suspected from the clinical course. 7 , 8 In the present case, coronary atherothrombosis was excluded by pre-operative CCTA findings.…”

Section: Discussionmentioning

confidence: 99%

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In vivo optical coherence tomography visualisation of coronary artery embolism caused by BioGlue in a middle-aged woman with Marfan syndrome who underwent the Bentall procedure: a case report

Hamaguchi,

Enomoto,

Kondo

et al. 2023

European Heart Journal - Case Reports

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Background Coronary artery embolism caused by BioGlue is a rare complication; therefore, its diagnosis and treatment remain undefined. Case summary A 47-year-old woman underwent ascending aortic replacement and coronary artery bypass grafting (CABG) for type A acute aortic dissection involving the right coronary artery ostium in 2017. Subsequently, she was diagnosed with Marfan syndrome. Five years later in 2022, she underwent aortic arch replacement, the Bentall procedure, and repeat CABG because of aortic root enlargement and aortic regurgitation progression. Twelve days after surgery, coronary computed tomography angiography (CCTA) revealed left anterior descending (LAD) artery stenosis, whereas pre-operative CCTA was normal. On post-operative day 13, coronary angiography revealed 99% LAD artery stenosis. Intravascular ultrasound (IVUS) showed a non-echoic mass with clear margins, and optical coherence tomography (OCT) demonstrated a crystalloid mass. Both images suggested that the embolus was inorganic matter, suspected as being the surgical adhesive BioGlue. We could not remove the embolus by repeated thrombectomy; therefore, drug-eluting stent implantation was performed. Seven months after surgery, she had no symptoms, and CCTA confirmed stent patency. Discussion To our knowledge, this is the first case report to describe BioGlue embolism observed by OCT. We performed an in vitro study using a blood vessel model, and the obtained OCT image was very similar to the in vivo image. Although BioGlue embolism is a rare complication, it should be considered in cases of perioperative myocardial infarction of uncertain aetiology, and coronary imaging is useful for diagnosis.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 97%