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Case report
Resection of a large mycotic aneurysm of the left anterior descending coronary artery
  1. Umar Ali,
  2. Nikki Stamp and
  3. Robert Larbalestier
  1. Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  1. Correspondence to Dr Umar Ali; umar.ali{at}health.wa.gov.au

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 Staphylococcus 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.

  • ischaemic heart disease
  • interventional cardiology
  • infectious diseases
  • cardiothoracic surgery

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Footnotes

  • Twitter @drnikkistamp

  • Contributors RL was the primary surgeon. NS was the first assistant. UA wrote the article and was involved in the patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.