PMC6795233_01
Coronary angiogram images before (
A) and after (
B) the first primary angioplasty of the right coronary artery.
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He underwent a successful primary angioplasty of the right coronary artery (RCA) with a bare metal stent ( Figure 1).
Coronary angiogram images of the second primary angioplasty:
A and
B show the intrastent thrombus with mycotic aneurysm of the right coronary artery.
C and
D show the right coronary artery angioplasty with an overlapping bare metal stent.
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An urgent coronary angiogram showed a thrombus with an aneurysm on the distal part of the RCA stent and a Thrombolysis In Myocardial Infarction (TIMI) 3 flow (normal flow) ( Figure 2A and 2B). An additional angioplasty using a second bare metal stent overlapping with the previous one was successfully performed with exclusion of the aneurysm and disappearance of the thrombus. ( Figure 2B and 2C).
Imaging showing tricuspid valve vegetation (arrow) with hematoma around the right coronary artery (arrowhead) and pericardial effusion in transthoracic echocardiography (
A and
B) and cardiac computed tomography scan (
C).
D: computed tomography coronary angiography showing the right coronary artery aneurysm excluded by the overlapping stent.
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Echocardiography showed vegetation (17 x 14 mm) at the level of the tricuspid valve with a moderate tricuspid regurgitation and a moderate pericardial effusion ( Figure 3A and 3B). Cardiac CT scan confirmed the vegetation in the right ventricle with hematoma around the RCA and pericardial effusion ( Figure 3C). Figure 3D). Following a thorough search for the underlying cause, we concluded that the temporary cardiac pacing was the most likely origin of the tricuspid valve infective endocarditis.