Resection of a large mycotic aneurysm of the left anterior descending coronary artery

Abstract

A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive S taphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.

Keywords: cardiothoracic surgery; infectious diseases; interventional cardiology; ischaemic heart disease.

Figure 1

Coronary angiogram (right anterior oblique 2° caudal 27°). The black arrow demonstrates the large mycotic aneurysm of the left anterior descending coronary artery. The red arrow demonstrates the circumflex coronary artery.

Figure 2

Coronary angiogram (right anterior oblique 2° caudal 27°). The black arrow demonstrates the drug-eluting stent in the left anterior descending coronary artery.

Figure 3

Intraoperative image demonstrating the well-formed pericardial adhesions over the left ventricle, shown by the black arrow. The blue arrow is pointing towards the head of the patient and the orange arrow is pointing towards the patient’s feet.

Figure 4

Intraoperative image demonstrating one of the large abscess cavities encountered at the LAD territory, shown by the black arrow. The blue arrow is pointing towards the head of the patient and the orange arrow is pointing towards the patient’s feet.