Kunioka Shingo, Tadokoro Naoki, Fujita Tomoyuki, Fukushima Satsuki
Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan.
Department of Cardiac Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan.
Eur Heart J Case Rep. 2023 Feb 16;7(3):ytad080. doi: 10.1093/ehjcr/ytad080. eCollection 2023 Mar.
Coronary artery embolism is a rare, life-threatening complication in patients with infectious endocarditis. Percutaneous transluminal coronary angioplasty is a common treatment; however, a coronary artery aneurysm may develop at the angioplasty site.
A 33-year-old women had been hospitalized in another institution due to cardiopulmonary arrest caused by embolic occlusion in the left main artery and infective endocarditis on mitral valve. Following extracorporeal membrane oxygenation insertion, she underwent percutaneous transluminal coronary angioplasty of the left main coronary artery and mitral valve replacement. She was transferred to our institution for advanced heart failure care. We immediately upgraded extracorporeal membrane oxygenation to an extracorporeal left ventricular assist device. Despite 6-week adequate medication, her left ventricular function was not improved. She was listed for heart transplantation on post-operative Day 40. Her blood culture showed negative results for 6 weeks. We planned to convert the left ventricular assist device from extracorporeal to implantable. However, pre-operative coronary artery angiography showed a large left main trunk coronary artery aneurysm on the stent site and rapid aneurysm enlargement. Surgery was performed on post-operative Day 48; the aneurysm was left unresected; its inflow and outflow arteries were completely ligated and supplemented by coronary artery bypass grafting. HeartMate 3 was implanted concomitantly, and the post-operative course was uneventful.
Coronary artery aneurysm at the angioplasty site was treated with adequate antibiotic therapy and simply ligation of the proximal and distal flow arteries of the aneurysm. Aneurysm ligation reduced invasive surgical procedures and provided time for concomitant surgery.
冠状动脉栓塞是感染性心内膜炎患者中一种罕见的、危及生命的并发症。经皮腔内冠状动脉成形术是一种常见的治疗方法；然而，在血管成形术部位可能会形成冠状动脉瘤。
一名33岁女性因左主干动脉栓塞性闭塞和二尖瓣感染性心内膜炎导致心肺骤停，曾在另一家机构住院治疗。在植入体外膜肺氧合后，她接受了左主干冠状动脉的经皮腔内冠状动脉成形术和二尖瓣置换术。她被转至我院接受晚期心力衰竭治疗。我们立即将体外膜肺氧合升级为体外左心室辅助装置。尽管进行了6周的充分药物治疗，她的左心室功能仍未改善。术后第40天，她被列入心脏移植名单。她的血培养6周结果均为阴性。我们计划将左心室辅助装置从体外型转换为植入型。然而，术前冠状动脉造影显示支架部位有一个巨大的左主干冠状动脉瘤，且动脉瘤迅速增大。术后第48天进行了手术；动脉瘤未切除；其流入和流出动脉被完全结扎，并辅以冠状动脉搭桥术。同时植入了HeartMate 3，术后过程顺利。
血管成形术部位的冠状动脉瘤采用充分的抗生素治疗，并简单结扎动脉瘤的近端和远端血流动脉进行治疗。动脉瘤结扎减少了侵入性手术操作，并为同期手术提供了时间。
