Catheter Cardiovasc Interv. 2014 Feb 15;83(3):E168-70. doi: 10.1002/ccd.24578.
Acute coronary syndromes in the setting of infective endocarditis may be the result of coronary compression secondary to periannular aortic valve complications, coronary embolism, obstruction of the coronary ostium due to a large vegetation, coronary atherosclerosis, and severe aortic insufficiency. External coronary artery compression as a result of infective endocarditis is a rare and lethal finding with few reported cases available in the medical literature. We present a rare occurrence of an acute coronary syndrome occurring in the setting of a bioprosthetic aortic valve abscess in which there was no complete coronary occlusion visualized and given the patient's recent unremarkable catheterization and findings of diffuse tapering of the proximal left coronary system, the most likely etiology was external compression secondary to the known aortic root abscess, which caused myocardial ischemia, and was confirmed during surgery. Although uncommon, external compression should be considered in the differential diagnosis of acute coronary syndrome in this setting and coronary angiography can be diagnostic of this entity.
感染性心内膜炎合并急性冠状动脉综合征可能是由于瓣周主动脉并发症导致冠状动脉受压、冠状动脉栓塞、大赘生物导致冠状动脉口阻塞、冠状动脉粥样硬化和严重主动脉瓣关闭不全所致。感染性心内膜炎引起的冠状动脉外部压迫是一种罕见且致命的发现，在医学文献中只有少数报道。我们报告了一例罕见的生物瓣主动脉瓣脓肿合并急性冠状动脉综合征病例，该病例未见完全冠状动脉闭塞，且患者最近的导管检查无明显异常，以及近端左冠状动脉系统弥漫性变细的发现，最可能的病因是已知主动脉根部脓肿导致的外部压迫，引起心肌缺血，并在手术中得到证实。虽然不常见，但在这种情况下，应考虑将外部压迫作为急性冠状动脉综合征的鉴别诊断，冠状动脉造影可对此进行诊断。
