Mycotic aneurysm of the proximal LAD successfully excluded with covered stents
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IMAGES IN CV APPLICATIONS
Mycotic aneurysm of the proximal LAD successfully excluded with covered stents Hampton A. Crimm1 · Junewai L. Reoma2 · Robert M. Gallagher1 Received: 17 June 2020 / Accepted: 27 June 2020 © Springer Nature B.V. 2020
Case description A 56-year-old male developed purulent pericarditis with tamponade due to methicillin-sensitive Staphylococcus aureus without systemic bacteremia. Despite pericardial drainage and intravenous broad-spectrum antibiotics, a loculated effusion persisted prompting surgical intervention with a subxiphoid pericardial window and intrapericardial thrombolysis. Restrictive pericarditis then developed, prompting surgical pericardiectomy. Preoperative, cardiac computed tomography angiography revealed an aneurysm of the proximal LAD (Fig. 1) which was further explored with
invasive coronary angiography (Online video 1). Surgical exclusion of the aneurysm was not possible due to intraoperative discovery of dense fibrinous adhesions. Due to concern for spontaneous rupture, institutional review board approval was granted for use of covered stents to exclude the large aneurysm of the proximal LAD. Following completion of antibiotics, percutaneous coronary intervention was performed with successful deployment two, overlapping, covered stents (3.5 × 16 mm and 4.0 × 19 mm) across the aneurysm (Online video 2). The patient fully recovered and remains stable at 2-year follow-up.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10554-020-01930-5) contains supplementary material, which is available to authorized users. * Hampton A. Crimm [email protected] 1
Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8930 Brown Drive, Building 9A, 2nd Floor, Bethesda, MD 20889, USA
Cardiothoracic Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
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The International Journal of Cardiovascular Imaging
Fig. 1 Cardiac CTA demonstrating mycotic coronary aneurysm with oblique (a, b), curved multiplanar (c) and short axis (d) views, cardiac CT demonstrates a large, partially calcified, broad-based aneurysm of the proximal LAD (yellow arrows) measuring 1.8 by 2.3 cm. Pericardial drains (red arrow) are also visible Ao Aorta, SVC Superior Vena Cava, RV right ventricle, LV left ventricle
Disclaimer The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency. The views expressed in this presentation are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
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