Zhao Jian, Yang Jing, Chen Wei, Yang Xiaomin, Liu Yaoting, Cong Xiaoliang, Huang Zhigang, Li Na
Department of Cardiology, Changzheng Hospital, Naval Medical University, Shanghai, China.
J Int Med Res. 2020 Dec;48(12):300060520980598. doi: 10.1177/0300060520980598.
Infective endocarditis is a bacterial or fungal infection of the heart valves or endocardial surface, and it frequently forms vegetation and can lead to systemic embolism. Dislodged vegetation rarely results in coronary artery embolism (CAE) and subsequent acute myocardial infarction. A 43-year-old male patient was emergently brought to our hospital for suspected acute myocardial infarction. Coronary angiography was performed and it showed embolism in the left circumflex artery. Thrombus aspiration was performed during coronary angiography. Echocardiography showed formation of vegetation in the posterior leaflet of the mitral valve and multiple blood cultures showed . Infective endocarditis was diagnosed. Three weeks later, debridement of subacute bacterial endocarditis, mitral valve replacement, and tricuspid valvuloplasty were successfully conducted. Our findings suggest that CAE should be considered in the differential diagnosis of acute myocardial infarction. Aspiration of coronary embolus during coronary angiography followed by surgical intervention of diseased heart valves is a plausible strategy for managing CAE in infective endocarditis.
感染性心内膜炎是心脏瓣膜或心内膜表面的细菌或真菌感染，常形成赘生物并可导致全身栓塞。脱落的赘生物很少导致冠状动脉栓塞（CAE）及随后的急性心肌梗死。一名43岁男性患者因疑似急性心肌梗死被紧急送往我院。进行了冠状动脉造影，显示左旋支动脉栓塞。冠状动脉造影时进行了血栓抽吸。超声心动图显示二尖瓣后叶有赘生物形成，多次血培养显示……诊断为感染性心内膜炎。三周后，成功进行了亚急性细菌性心内膜炎清创术、二尖瓣置换术和三尖瓣成形术。我们的研究结果表明，在急性心肌梗死的鉴别诊断中应考虑CAE。冠状动脉造影时抽吸冠状动脉栓子，随后对病变心脏瓣膜进行手术干预，是治疗感染性心内膜炎中CAE的一种可行策略。
