Septic coronary embolization in a patient with congenitally corrected transposition of the great arteries
After 3 weeks of inpatient intravenous antibiotics, the patient experienced sudden onset of severe chest pain with evidence of pulmonary edema, hypoxemia, and cardiogenic shock. ECG showed anterior ST-segment elevation. Emergency coronary angiography showed complete occlusion of the morphologic left anterior descending artery (Fig. 2a and Supplementary Movie 1, Supplemental digital content 1, http://links.lww.com/MCA/A149). Embolectomy with AngioJet (Boston Scientific; Marlborough, Massachusetts, USA) thrombectomy catheter was unsuccessful. Eventually, perfusion was restored with balloon angioplasty and bare-metal stent (Fig. 2b and Supplementary Movie 2, Supplemental digital content 2, http://links.lww.com/MCA/A150). During the procedure the patient experienced ventricular fibrillation that necessitated defibrillation and antiarrhythmic therapy. Troponin peaked at more than 80 ng/ml.
Eight days following percutaneous intervention (PCI), the patient underwent bioprosthetic aortic valve replacement. Several months after discharge, the patient died following readmission with septic/cardiogenic shock due to methicillin-resistant S. aureus prosthetic valve endocarditis.