Cardiovasc Imaging Asia.  2024 Jul;8(3):64-67. 10.22468/cvia.2024.00094.

Myocardial Infarction Caused by Coronary Artery Compression From Perivalvular Abscess

• Jung J
• Kim GJ
• Oh TH

• KMID: 2558381
• DOI: http://doi.org/10.22468/cvia.2024.00094

Abstract

Infective endocarditis involving a prosthetic valve significantly increases the risk of mortality. Extrinsic coronary compression caused by perivalvular abscess in prosthetic valve endocarditis is extremely rare. We present a case of a 40-year-old man with chest pain and fever who had undergone tissue aortic valve replacement 15 years prior. He underwent coronary angiography due to refractory chest pain. Intracoronary nitrate exacerbated symptoms and caused instability in his vital signs despite vasospastic features on coronary angiography. Intravascular ultrasonography revealed a triangular deformation of the proximal left circumflex artery. He received percutaneous coronary intervention on the left circumflex artery with a drugeluting stent, followed by a redo aortic valve replacement. Upon surgical inspection, an abscess had formed due to the prosthetic valve endocarditis was found, and was compressing his coronary artery. In patients suspected of infective endocarditis with myocardial infarction, suspicion of coronary artery compression due to perivalvular abscess should be considered. Distinctive features detected via intravascular ultrasonography can aid in diagnosis. Furthermore, we propose that percutaneous coronary intervention may serve as a bridge to valve replacement surgery, allowing time for restoration of ischemic myocardium.

Keyword

Coronary angiography; Intravascular ultrasonography; Myocardial infarction; Percutaneous coronary intervention; Prosthetic valve endocarditis