Mazzoni Carlotta, Scheggi Valentina, Marchionni Niccolò, Stefano Pierluigi
Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Eur Heart J Case Rep. 2021 Jul 29;5(9):ytab302. doi: 10.1093/ehjcr/ytab302. eCollection 2021 Sep.
Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in <1% of cases.
A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up.
Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy.
冠状动脉栓塞是2型心肌梗死的一种罕见病因，其可由动脉血栓栓塞或脓毒性栓塞引起。虽然全身栓塞是感染性心内膜炎最常见且最具威胁性的并发症之一，但导致急性心肌梗死的冠状动脉栓塞极为罕见，发生率<1%。
一名52岁男性，有Bentall手术史，因人工瓣膜退变（本次就诊前11年）接受再次主动脉瓣置换术，因高热和肌痛就诊于急诊科。到达后不久，他出现典型胸痛，心电图显示下壁ST段抬高型心肌梗死迹象：冠状动脉造影显示在旋支冠状动脉中远段水平有一个推测为栓塞起源的病变，行栓子切除术治疗。经胸和经食管超声心动图显示主动脉周围脓肿。正电子发射断层扫描-计算机断层扫描（PET-CT）检查及多次血培养结果证实了感染性心内膜炎是脓毒性冠状动脉栓塞病因的最终诊断。患者成功接受再次Bentall手术，1个月随访时证实预后良好。
冠状动脉栓塞所致2型心肌梗死是感染性心内膜炎的一种罕见表现，其诊断需要高度怀疑。人工心脏瓣膜是感染性心内膜炎的一个易感因素：主动脉根部脓肿需要手术治疗，因为抗生素治疗很少能使其消退。
