Septic Coronary Embolism—A Rare Complication of Bacterial Endocarditis in a GUCH Patient

Background: Septic embolism in coronary arteries is a rare but serious complication, primarily linked to conditions such as infective endocarditis. Knowledge of the disease, anticipation of problems, and good interdisciplinary clinical care of patients at risk are crucial to a safe life.

Methods: Here, we report about a 20-year-old female patient with Truncus arteriosus Typ II after surgical repair. While on treatment for bacterial endocarditis (BE) of the truncal (aortic) valve caused by streptococcus oralis with penicillin G and gentamycin for 1 week, she developed septic embolism in the left coronary artery after having vegetation in the left ventricular outflow tract. Clinically, she presented with a sudden onset of thoracic pain and dyspnea, the ECG showed ST-elevation myocardial infarction. The catheterization of the left heart revealed a complete obstruction of segment 7/8 of LAD. Using a balloon catheter, the obstruction was relieved and by the aid of a suction device, the thrombus was subducted. After successful intervention, the patient recovered completely without major infarction.

Conclusion: This case report presents a very rare complication of infective endocarditis. Nevertheless, it is important to anticipate such events and react quickly to clinical signs related to myocardial infarction in patients at high risk of BE such as after cardiac surgery and patients with endoprosthesis material. Although embolization into the brain, spleen, or kidneys is more common, embolization into coronary arteries is possible and will result in myocardial infarction and possible death. Knowing about this complication, although very rare, is crucial when taking care of such patients. Immediate interdisciplinary management (adult coronary specialists, GUCH specialists) seems crucial for optimal outcomes. As this case report shows optimal treatment of such patients cannot only save their lives but can lead to restitutio ad integrum.

Publication History

Article published online:
11 February 2025