Mycotic Aneurysm of the Left Anterior Descending Coronary Artery After Coronary Artery Bypass Graft Surgery

Mycotic Pseudoaneurysms of the Coronary Arteries

“…Numerous mechanisms have been implicated in the development of mycotic aneurysms including embolic occlusion and sterile infarction of the vaso vasorum, injury due to immune complexes in the arterial wall and direct bacterial invasion in a setting of acute infective endocarditis . In this case, although the patient had severe coronary artery disease he showed no evidence of infective endocarditis.…”

“…They are most commonly associated with atherosclerosis in adults, and Kawasaki disease in children, with less common causes being congenital malformations, trauma, dissection, connective tissue disorders, systemic lupus erythematous and complications of coronary angioplasty, and vasculitis . Mycotic aneurysms of the coronary arteries are extremely rare, accounting for less than 3% of all coronary aneurysms, with the first case reported in 1812 . It is a commonly fatal condition, requiring prompt surgical management to prevent rupture and subsequent tamponade, or acute myocardial infarction .…”

“…The natural history of mycotic aneurysms of the coronary arteries is unclear. While it is thought smaller aneurysms may be managed conservatively with long‐term antibiotic therapy, larger aneurysms require surgical management . Given the inherent risk of enlargement of the aneurysm and subsequent rupture, the treatment modality of choice for mycotic aneurysms of the coronary arteries has been surgery since the first successful procedure in 1970 .…”

“…3,4 Mycotic aneurysms of the coronary arteries are extremely rare, accounting for less than 3% of all coronary aneurysms, with the first case reported in 1812. 4,5 It is a commonly fatal condition, requiring prompt surgical management to prevent rupture and subsequent tamponade, or acute myocardial infarction. 3 They are most commonly associated with bacterial endocarditis, but have also been reported in patients with sepsis following percutaneous coronary intervention and postcoronary artery bypass graft surgery.…”

“…While it is thought smaller aneurysms may be managed conservatively with longterm antibiotic therapy, larger aneurysms require surgical management. 5 Given the inherent risk of enlargement of the aneurysm and subsequent rupture, the treatment modality of choice for mycotic aneurysms of the coronary arteries has been surgery since the first successful procedure in 1970. 4 Although the timing of surgery is not well defined, the literature supports urgent aneurysmal resection and CABG to avoid the risks of aneurysmal rupture.…”