John Hunter Hospital, Newcastle, NSW, Australia.
John Hunter Hospital, Newcastle, NSW, Australia.
Heart Lung Circ. 2020 Jan;29(1):128-136. doi: 10.1016/j.hlc.2018.12.004. Epub 2018 Dec 19.
Mycotic coronary aneurysms (MCA) are rare but often lead to significant morbidity and mortality. Evidence on the topic is limited to case reports and small case series. A systematic review was performed to improve understanding of this challenging diagnosis. A case report prompting this review is also included.
Relevant articles were identified by searching databases Medline and Google Scholar for terms 'mycotic coronary aneurysm'. Manual searching from article references identified further case reports.
Ninety-seven (97) published cases of MCA were identified between 1812 and 2017; 80 cases since the introduction of percutaneous coronary intervention (PCI) with stents in 1986. The most common associations were PCI (40.0%) and infective endocarditis (IE) (40.0%). Complications including aneurysm rupture (28.9%), pericardial effusion (37.3%) and myocardial infarction (39.8%) were frequent. Short-term mortality was high at 42.6%. The most common treatment was surgical resection of the aneurysm with bypass grafting.
We present a case and the largest systematic review to date of this rare diagnosis, identifying 97 published case reports. Clinical scenarios in which to consider MCA include febrile illness after recent PCI, febrile illness (particularly infective endocarditis) with evidence of coronary ischaemia, and purulent pericarditis. Given the high rate of complications and mortality, immediate surgical referral is recommended.
真菌性冠状动脉瘤（MCA）较为罕见，但常导致严重的发病率和死亡率。该主题的证据仅限于病例报告和小病例系列。进行了系统评价，以提高对这一具有挑战性的诊断的认识。本综述还包括了一个促使进行该综述的病例报告。
通过在 Medline 和 Google Scholar 数据库中搜索“真菌性冠状动脉瘤”一词，确定了相关文章。从文章参考文献中手动搜索进一步确定了其他病例报告。
1812 年至 2017 年间共发现 97 例 MCA 已发表病例；1986 年经皮冠状动脉介入治疗（PCI）伴支架置入后有 80 例。最常见的相关因素是 PCI（40.0%）和感染性心内膜炎（IE）（40.0%）。常见并发症包括动脉瘤破裂（28.9%）、心包积液（37.3%）和心肌梗死（39.8%）。短期死亡率高达 42.6%。最常见的治疗方法是动脉瘤切除术和旁路移植术。
我们提出了一个病例，并对这一罕见诊断进行了迄今为止最大的系统评价，共确定了 97 例已发表的病例报告。需要考虑 MCA 的临床情况包括：近期 PCI 后发热性疾病、有冠状动脉缺血证据的发热性疾病（特别是感染性心内膜炎）和脓性心包炎。鉴于并发症和死亡率高，建议立即转外科治疗。
