Successful Surgical Treatment of an Infected Right Coronary Artery Aneurysm-to-Right Ventricle Fistula after Sirolimus-eluting Stent Implantation

Abstract

Abstract

Successful percutaneous treatment of a mycotic right coronary to right ventricle fistula

“…Acquired mycotic coronary fistulas are very rare, having been reported on four occasions previously [1][2][3][4] ; similar to our case, all cases occurred in the setting of staphylococcal sepsis and underlying renal impairment. These cases were, however, managed surgically with histology confirming a mycotic process.…”

Infections of Intravascular Bare Metal Stents: A Case Report and Review of Literature

“…4 This fact is underlined by the remarkable increase of reported infected coronary stents in the last decade: from the 24 coronary stent infection cases reported since 2003, 16 cases were with drug eluting stents (Tables 1 and 3). 43e 45,53,54,56,57,59,61,62,67e69,72,73 The drugs eluded by the stent were rapamycine, 43 sirolimus, 45,53,56,57,61,69 paclitaxel, 44,53,54,59,72 and everolimus. 68 The local inflammation, which leads to neointimal growth (caused by proliferation of smooth muscle cells), neointimal hyperplasia, and eventually restenosis, is inhibited by the immunosuppressive effects of the drugs.…”

“…68 The local inflammation, which leads to neointimal growth (caused by proliferation of smooth muscle cells), neointimal hyperplasia, and eventually restenosis, is inhibited by the immunosuppressive effects of the drugs. 45,57,59,69 However, this inhibition of neointimal growth may lead to the fact that metallic stents remain uncovered intraluminally, forming an ideal nidus for passing bacteria. 59,72 This is underlined as in seven of the 16 cases the infection took place later then the first 4 weeks after stent placement (Table 1).…”

“…59,72 This is underlined as in seven of the 16 cases the infection took place later then the first 4 weeks after stent placement (Table 1). 53,54,57,59,61,62,72,73 This relatively high infection rate is a concerning side effect of drug eluting stents, which cannot be neglected. Gonda et al underline the fact that, given the large number of DES that are currently implanted worldwide, the problem may be more common than currently evident and thus physicians should be cognizant of this potential complication.…”

“…31.0 a When the authors described their procedure as "standard" or "uncomplicated", we assumed that the catheter was removed with 6 hours of placement. To prove active infection, nuclear imaging such as WBC-scans 4,12,18,25,29,32,34,47,50,57,58,62,67,68 and PETscans 67,72 can be used. A WBC-scan was performed in 16 cases, of which 10 were true positive, and six were false negative ( Table 7).…”