title: Successful surgical treatment of a mycotic right coronary artery aneurysm complicated by a fistula to the right atrium.
abstract: We reported successful surgical treatment of a mycotic right coronary artery aneurysm complicated by a fistula to the right atrium in a 60-year-old man admitted to hospital because of acute worsening of renal function and erythroderma. After admission, he suffered from methicillin-resistant Staphylococcus aureus septicemia. Despite administration of vancomycin hydrochloride, a low-grade fever persisted. Subacute cardiac tamponade occurred three months after admission, and acute inferior wall myocardial infarction occurred two weeks after pericardial drainage. An emergent coronary angiography demonstrated a large saccular aneurysm of the right coronary artery forming a fistula to the right atrium and obstruction of the distal right coronary artery. We emergently resected the aneurysm including the right atrial wall and repaired the defect in the right atrium. Pathological examination of the aneurysmal wall revealed its mycotic nature; the postoperative course was uneventful.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Bito
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000785:Aneurysm, Infected / Q000175:diagnosis / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy; D006348:Cardiac Surgical Procedures / Q000379:methods; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000601:surgery*; D017023:Coronary Angiography; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents