A unique case report of mitral valve endocarditis associated with coronary stent infection

Background Despite increasing use of percutaneous coronary intervention (PCI) and stenting, septic complications such as coronary stent infections are rare. We report a unique case of mitral valve infective endocarditis and associated coronary stent infection which emerged six months after index stent insertion. Case Presentation A 56-year-old previously healthy man underwent percutaneous coronary intervention and stenting of left circumflex (LCx) coronary artery in the setting of non-ST segment elevation myocardial infarction. Six months later, he represented with inferior ST-segment elevation myocardial infarction and was found to have a coronary pseudo-aneurysm of stented segment of LCx. The pseudo-aneurysm was treated with insertion of a covered stent, and immediately following that he developed sepsis with methicillin sensitive staphylococcus aureus bacteraemia. Comprehensive work-up resulted in the diagnosis of mitral valve endocarditis complicated by coronary stent infection and myocardial abscess formation. He was managed with initial prolonged systemic antibiotic treatment followed by mitral valve replacement. Post-operative course was uneventful with a short duration of oral antibiotics. At six-year Follow-up, patient was well with satisfactory echocardiographic result. Discussion This is a very rare case of mitral valve endocarditis with extensive cardiac involvement including coronary stent infection and surrounding myocardial abscess. Stents can act as an ideal vector for bacterial adherence from which bacteria could spread to the arterial wall and adjacent myocardium. This case suggests a potential complication of delayed endothelialisation and risk of infective complication due to bacterial seeding or embolisation.

A case of septic shock which postmortem pathological autopsy revealed bacterial myocardial abscess

Background and purpose: The myocardial abscess is a scarce condition, but it is significant due to its high mortality. We aimed to seek insight into myocardial abscess by presenting a case report. Methods: A 73 years old male was emergently transferred to our hospital with disorientation and hypotension. He had a past medical history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and calculous cholecystitis. He had complained of lumbago since 1 week before arrival at our hospital. We diagnosed him with septic shock due to pyogenic spondylitis and psoas abscess by the laboratory and imaging findings. We could not find abnormality in his cardiac status of echocardiography. Despite the treatment, his condition worsened rapidly, and he died after 24 hours of arrival. We performed a postmortem pathological autopsy, which revealed the condition of myocardial abscesses. We examined medical literature about a myocardial abscess. Results: According to a previous treatise, pyogenic spondylitis was reported as a causative disease of the myocardial abscess to the same extent as infective endocarditis. Bacterial myocarditis may lead to decreased cardiac function and arrhythmias. Our case did not show cardiac asynergy, decreased cardiac function, and sudden fatal arrhythmias during the course. We thought that the myocardial abscess was due to a hematogenous metastasis from the pyogenic spondylitis. And we thought the direct cause of death was septic shock, not the myocardial abscess. Conclusions: We experienced a fatal septic shock case that revealed myocardial abscess by the postmortem pathological autopsy. It is possible that we cannot notice the existence of myocardial abscess without a pathological autopsy.

Isolated Emphysematous Myocardial Abscess without Infective Endocarditis

A myocardial abscess is a rare and fatal disease, which is known to be challenging to diagnose, especially in case of isolated one without endocarditis. We present a case of emphysematous myocardial abscess detected by computed tomography, and echocardiography, and confirmed by surgery.

Dying from haemorrhagic cardiac tamponade – a case series

Cardiac tamponade is a condition produced by the rapid accumulation of pericardial fluid, which restricts the filling of the heart. Often the forensic pathologist comes across different naturally occurring sudden deaths. Cardiovascular causes are the most common. Death due to cardiac tamponade can cause sudden cardiac death. Acute cardiac tamponade is almost invariably fatal, unless the pressure is relieved by removing the pericardial fluid, either by needle pericardiocentesis or surgical procedures. Cardiac tamponade is more commonly associated with cases of trauma, operative procedures, secondary to myocardial infarction or intra pericardial rupture of great vessels. Previous literature showed an association of cardiac tamponade with many other pathological conditions such as malignancy, central venous catheterisation, open heart surgery, dissecting aneurysm of the aorta, myocardial abscess, infective endocarditis, etc. We report a series of three cases where cardiac tamponade was given as the cause of death on autopsy secondary to post-myocardial infarction wall rupture.