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Updated: Feb 14, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Primary percutaneous coronary intervention during ST elevation myocardial infarction in prosthetic valve
Alfonso Campanile1, Guido Tavazzi2, Francesco Caprioglio3
1Department of Cardiology, Hospital "S. M. della Misericordia", Perugia, Italy. alfonsocampanile@hotmail.it.
Insights
Infective endocarditis can cause rare aortic root abscesses leading to myocardial infarction. This case highlights the critical need for prompt diagnosis and intervention in high-risk patients to improve outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Infective endocarditis (IE) presents significant mortality, particularly in elderly patients and those with prosthetic valves.
- Prompt management and timely therapy are crucial for mitigating IE complications.
- Multimodality imaging plays a vital role in the early detection and management of IE.
Observation:
- A rare case of myocardial ischemia caused by extrinsic coronary compression from an aortic abscess is presented.
- An 82-year-old female with a prosthetic valve developed acute coronary syndrome due to an aortic root abscess.
- Despite attempted percutaneous revascularization, the patient experienced rapid deterioration and mortality.
Findings:
- The case demonstrates an extremely rare cause of ST-elevation myocardial infarction: an aortic root abscess.
- Percutaneous stent implantation was attempted to address coronary compression, but was ultimately unsuccessful in preventing mortality.
- The patient's rapid decline underscores the severity of this rare complication.
Implications:
- Prompt diagnostic workup, including trans-esophageal echocardiography, is essential for patients with fever, endocarditis risk factors, and acute coronary syndrome.
- The optimal timing for echocardiographic follow-up and surgical intervention in IE requires further investigation.
- This case emphasizes the importance of timely management to prevent severe complications and improve patient prognosis in infective endocarditis.
Background:
Infective endocarditis (IE) is still a condition with high mortality and morbidity, especially in the elderly, and in patients with prosthetic valves. The concept of "time-to-therapy" plays a key role for the prompt management of IE and related complications, and the currently available multimodality imaging may play a key role in this setting. Myocardial ischemia due to extrinsic coronary compression from an aortic abscess is an extremely rare condition where the optimal therapeutic strategy has not been defined yet. We present herein the first case of a patient with ST elevation myocardial infarction caused by an aortic root abscess treated with percutaneous stent implantation.
Case Presentation:
An 82-year-old woman with a history of atrial fibrillation, chronic renal failure, anemia and a bioprosthetic aortic valve replacement performed in 2014, was admitted to hospital with profound asthenia and a pyrexia of unknown origin. Because of high clinical suspicion of endocarditis, a trans-esophageal echocardiogram was performed. Empirical broad-spectrum antimicrobial therapy was initiated, followed by targeted treatment based on the results of blood cultures (Staphylococcus aureus). The echocardiogram did not show vegetations and the patient was managed conservatively. She suddenly deteriorated, due to an acute coronary syndrome (ACS) with anterior ST segment elevation. An urgent angiogram was performed, and extrinsic compression of the left coronary system, due to an aortic root abscess, was suspected. After discussion with the surgical team, percutaneous revascularization was attempted, aiming to restore satisfactory hemodynamics, in order to plan surgery. Unfortunately, the patient rapidly developed cardiogenic shock, with multi organ failure, and died in less than 24 h.
Conclusions:
Patients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography. At present, the specific timing of echocardiographic follow-up and surgical intervention is still a matter of debate, and our case aims to highlight the importance of this aspect in the management of endocarditis, in order to avoid severe complications that adversely affect patient prognosis.
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