Resection of a large mycotic aneurysm of the left anterior descending coronary artery

Abstract

A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive Staphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.

Multiple mycotic arterial aneurysms involving the left anterior descending coronary artery following mitral and aortic valve endocarditis: A case report

“…Mycotic aneurysm of LAD was reported in association with an infected coronary artery stent 1 . The culture of this patient had grown Staphylococcus aureus and he was managed with stent removal and coronary artery bypass grafting.…”

“…Mycotic aneurysm of LAD was reported in association with an infected coronary artery stent. 1 The culture of this patient had grown Because of the preoperative patient condition and the associated renal failure and intracranial hemorrhage, we bypassed the LAD using a vein graft to decrease the operative time and decrease the incidence of postoperative sternal wound infection. Additionally, the patient had widespread vasculitic cutaneous lesions and mycotic aneurysms in three arteries.…”

“…Mycotic left anterior descending (LAD) coronary artery aneurysm is a rare condition with serious consequence and fatal outcome if left untreated. The condition can occur as a complication of infective endocarditis, systemic infections, or infection of the coronary artery stent 1,2 . Coronary artery mycotic aneurysms occur in less than 2% of patients with infective endocarditis, 3 and they can occur in association with other mycotic aneurysms or as an isolated lesion 4 .…”

“…The condition can occur as a complication of infective endocarditis, systemic infections, or infection of the coronary artery stent. 1,2 Coronary artery mycotic aneurysms occur in less than 2% of patients with infective endocarditis, 3 and they can occur in association with other mycotic aneurysms or as an isolated lesion. 4 There is no consensus on the management of these patients; however, surgical intervention is required to prevent fatal complications.…”

Mycotic Coronary Aneurysm Associated With Biventricular Fistula

“…Their incidence is higher in immunocompromised patients and patients with neoplasm but also in diabetic individuals. 5 The incriminated germs are typically Staphylococcus aureus and Streptococcus viridans . Most patients present with symptoms such as fever, chills, or lethargy with no pathognomonic features.…”