Asian Cardiovasc Thorac Ann 2005;13:199
© 2005 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Septic Embolic Occlusion of Left Anterior Descending Artery
Sujit Nair, MRCS,
Pankaj Kumar, FRCS,
Neil Moat, FRCS
Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
For reprint information contact: Sujit Nair, MRCS Tel: 44 793 205 7927 Fax: 44 207 351 8564 Email: drsnnair{at}hotmail.com, 21 Shearsby Drive, Forest Town, Mansfield, NG19 0RN, United Kingdom.
A 68-year old hypertensive and diabetic male with known third degree haemorrhoids presented with a 5-months history of dyspnoea, orthopnoea, fever and weight loss. On physical examination he was pyrexial with a sinus tachycardia (140 beats·min–1), raised JVP (+8 cm), bilateral basal crepitations and a loud pan systolic murmur.
Chest radiograph confirmed florid pulmonary oedema. Enteroccocus feacalis was isolated from blood cultures. Electrocardiogram confirmed sinus tachycardia with signs of septal infarction. Echocardiogram showed severe mitral regurgitation. Transoesophageal echocardiogram confirmed mitral valve endocarditis with multiple vegetations on the anterior leaflet and posterior leaflet (Figure 1
). Coronary angiography showed occluded left anterior descending artery (LAD) beyond its midcourse (Figure 2).
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Figure 1. Transoesophageal echocardiogram showing multiple vegetations on the anterior and posterior mitral valve leaflets.
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Intra-operatively, there was palpable material occluding the LAD from middle third to the apex of the left ventricle. Revascularisation of the LAD was not felt to be necessary, as the patient had already sustained septal infarction. Successful complex mitral valve reconstruction was undertaken.
Embolic coronary artery occlusion is rare complication of endocarditis. We present the images of this rare complication.
