Why the study?
Infected coronary artery aneurysm with infected pericardial effusion is a rare post-PCI complication with high mortality, and the optimal management strategy remains unknown.
Does non-operative management improve survival in a patient with infected coronary artery aneurysm and infected pericardial effusion complicated by multi-organ failure?
Does non-operative management improve survival in a patient with infected coronary artery aneurysm and infected pericardial effusion complicated by multi-organ failure?
Non-operative management with a pericardial window can result in survival and recovery in patients with infected coronary artery aneurysm and pericardial effusion who are too high risk for surgery.
This rare case adds to sparse reports on post-PCI infected aneurysms; leaves optimal management open pending higher-level evidence.
Background Infected coronary artery aneurysm with infected pericardial effusion is a very rare complication following percutaneous coronary intervention (PCI) and is associated with high mortality. Management options include open cardiothoracic surgery or non-operative management with pericardiocentesis. The best management option is currently unknown. Case summary A 76-year-old man with a background of hypertension, type two diabetes mellitus, chronic kidney disease, and a pacemaker presented with worsening shortness of breath 5 weeks following PCI to the right coronary artery (RCA) for a non-ST elevation myocardial infarction. His blood cultures grew methicillin-sensitive Staphylococcus aureus and he developed progressive renal failure and shortness of breath despite high-dose antibiotics. Echocardiography showed a pericardial effusion with impending tamponade and the patient proceeded urgently for pericardiocentesis. He subsequently developed severe cardiogenic and vasoplegic shock with multi-organ failure. Computed tomography coronary angiography (CTCA) showed an RCA aneurysm. He was conservatively managed with a pericardial window due to being too high risk for cardiac surgery and subsequently made a full recovery. Discussion Non-operative management of infected coronary artery aneurysm and infected pericardial effusion resulted in survival and return to baseline function in our patient despite the development of severe shock with multi-organ failure.
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Wareing et al. (2022) studied this question.
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