Rare case of very late coronary stent infection with resultant coronary cameral fistula and infective endocarditis: Diagnosis and management

IHJ Cardiovascular Case Reports (CVCR) Pub Date : 2023-04-01 DOI:10.1016/j.ihjccr.2023.06.001

Palled Santosh , Christopher Johann , Punna Praveen kumar , Rama Subramanyam G , Khanapur Raghavendra

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Abstract

66yrs old, Male, presented to our hospital with history of low-grade fever of one month duration. Only significant past history was right coronary artery (RCA)stenting done a year ago. Physical examination no localizing signs of fever. Blood culture identified pseudomonas aeruginosa. Electrocardiogram (ECG) showed old inferior wall myocardial infarction changes. Echocardiography (ECHO) detected myocardial abscess along the right atrioventricular groove and vegetation on tricuspid valve. Coronary angiogram showed totally occluded and infected RCA stent with formation of coronary cameral fistula, draining into right atrium. A positron emission tomography (PET) scan and a computed tomography (CT) scan showed increased tracer uptake in RCA stent, peri-stent abscess. Infected stent, artery, and vegetation removed surgically, then graft given to distal RCA. The multi-diagnostic modality helped in identifying this condition early. Timely surgical intervention helped the patient to recover in otherwise life-threatening complication.

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罕见的晚期冠状动脉支架感染并发冠状动脉cameral瘘和感染性心内膜炎病例:诊断和处理

66岁，男，有1个月低烧病史。唯一重要的既往病史是一年前做的右冠状动脉支架置入术。体格检查无局部发热迹象。血培养鉴定为铜绿假单胞菌。心电图显示陈旧性下壁心肌梗死改变。超声心动图（ECHO）检测到右房室沟和三尖瓣上有心肌脓肿。冠状动脉造影显示RCA支架完全闭塞并感染，形成冠状动脉造影瘘，引流至右心房。正电子发射断层扫描（PET）和计算机断层扫描（CT）显示RCA支架和支架周围脓肿的示踪剂摄取增加。手术切除受感染的支架、动脉和植被，然后移植到远端RCA。多种诊断模式有助于早期发现这种情况。及时的手术干预有助于患者在其他危及生命的并发症中康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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IHJ Cardiovascular Case Reports (CVCR)

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