PDF(Pubmed)
Abstract：
BACKGROUND: Infective endocarditis (IE) management is challenging, usually requiring multidisciplinary collaboration from cardiologists, infectious disease specialists, interventional cardiologists, and cardiovascular surgeons, as more than half of the cases will require surgical procedures. Therefore, it is essential for all healthcare providers involved in managing IE to understand the disease\'s characteristics, potential complications, and treatment options. While systemic embolization is one of the most frequent complications of IE, the coronary localization of emboli causing acute myocardial infarction (AMI) is less common, with an incidence ranging from 1% to 10% of cases, but it has a much higher rate of morbidity and mortality. There are no guidelines for this type of AMI management in IE.
METHODS: This narrative review summarizes the current knowledge regarding septic coronary embolization in patients with IE. Additionally, this paper highlights the diagnosis and management challenges in such cases, particularly due to the lack of protocols or consensus in the field.
RESULTS: Data extracted from case reports indicate that septic coronary embolization often occurs within the first two weeks of the disease. The aortic valve is most commonly involved with vegetation, and the occluded vessel is frequently the left anterior descending artery. Broad-spectrum antibiotic therapy followed by targeted antibiotic therapy for infection control is essential, and surgical treatment offers promising results through surgical embolectomy, concomitant with valve replacement or aspiration thrombectomy, with or without subsequent stent insertion. Thrombolytics are to be avoided due to the increased risk of bleeding.
CONCLUSIONS: All these aspects should constitute future lines of research, allowing the integration of all current knowledge from multidisciplinary team studies on larger patient cohorts and, subsequently, creating a consensus for assessing the risk and guiding the management of this potentially fatal complication.
METHODS: This narrative review summarizes the current knowledge regarding septic coronary embolization in patients with IE. Additionally, this paper highlights the diagnosis and management challenges in such cases, particularly due to the lack of protocols or consensus in the field.
RESULTS: Data extracted from case reports indicate that septic coronary embolization often occurs within the first two weeks of the disease. The aortic valve is most commonly involved with vegetation, and the occluded vessel is frequently the left anterior descending artery. Broad-spectrum antibiotic therapy followed by targeted antibiotic therapy for infection control is essential, and surgical treatment offers promising results through surgical embolectomy, concomitant with valve replacement or aspiration thrombectomy, with or without subsequent stent insertion. Thrombolytics are to be avoided due to the increased risk of bleeding.
CONCLUSIONS: All these aspects should constitute future lines of research, allowing the integration of all current knowledge from multidisciplinary team studies on larger patient cohorts and, subsequently, creating a consensus for assessing the risk and guiding the management of this potentially fatal complication.
摘要：
背景：感染性心内膜炎（IE）的管理具有挑战性，通常需要心脏病专家的多学科合作，传染病专家,介入心脏病学家,和心血管外科医生，因为超过一半的病例将需要外科手术。因此,对于所有参与管理IE的医疗保健提供者来说，了解这种疾病的特征是至关重要的，潜在的并发症,和治疗选择。虽然全身性栓塞是IE最常见的并发症之一，引起急性心肌梗死（AMI）的栓子的冠状动脉定位较少见，发病率从1%到10%不等，但是它的发病率和死亡率要高得多。IE中没有针对此类AMI管理的指南。
方法：这篇叙述性综述总结了目前有关IE患者的脓毒症冠状动脉栓塞的知识。此外,本文重点介绍了此类病例的诊断和管理挑战，特别是由于该领域缺乏协议或共识。
结果：从病例报告中提取的数据表明，化脓性冠状动脉栓塞通常发生在疾病的前两周内。主动脉瓣最常见于植被，闭塞的血管通常是左前降支。广谱抗生素治疗后的靶向抗生素治疗对于控制感染至关重要。手术治疗通过手术栓子切除术提供了有希望的结果，伴随着瓣膜置换或抽吸血栓切除术，有或没有随后的支架插入。由于出血风险增加，应避免溶栓。
结论：所有这些方面都应构成未来的研究方向，允许将来自多学科团队研究的所有当前知识整合到更大的患者队列中，随后,就评估风险和指导这种潜在致命并发症的管理达成共识。
方法：这篇叙述性综述总结了目前有关IE患者的脓毒症冠状动脉栓塞的知识。此外,本文重点介绍了此类病例的诊断和管理挑战，特别是由于该领域缺乏协议或共识。
结果：从病例报告中提取的数据表明，化脓性冠状动脉栓塞通常发生在疾病的前两周内。主动脉瓣最常见于植被，闭塞的血管通常是左前降支。广谱抗生素治疗后的靶向抗生素治疗对于控制感染至关重要。手术治疗通过手术栓子切除术提供了有希望的结果，伴随着瓣膜置换或抽吸血栓切除术，有或没有随后的支架插入。由于出血风险增加，应避免溶栓。
结论：所有这些方面都应构成未来的研究方向，允许将来自多学科团队研究的所有当前知识整合到更大的患者队列中，随后,就评估风险和指导这种潜在致命并发症的管理达成共识。
