A Case of Surgical Treatment of Infected Coronary Artery Aneurysm Caused by Prosthetic Graft Infection

Abstract

A 76-year-old man underwent graft replacement of the abdominal aorta with the right femoral artery-left femoral artery bypass grafting for a ruptured abdominal aortic aneurysm in 2014. In 2017, the patient had sepsis due to infection of the femoral bypass graft. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the blood cultures. He was transferred to our institution because of his worsening general condition. We removed the prosthetic bypass graft and administered antibiotic therapy for MRSA. The MRSA was cleared from his blood on post operative day 3. Two weeks after surgery, he was observed to have a high fever and a right coronary artery infected aneurysm of diameter 55 mm was revealed by computed tomography. Angiography revealed 90% stenosis in the proximal lesion of the right coronary artery with severe calcification. We performed emergent debridement of the infected cardiac tissue, ligation of the proximal of right coronary artery, and bypass grafting to the distal right coronary artery via the great saphenous vein. The patient recovered and was discharged from our institution without infection recurrence. Coronary artery aneurysms are rare, and infected coronary artery aneurysms are even rarer. We have reported this along with a literature review.