title: Prosthetic Aortic Valve Endocarditis with Left Main Coronary Artery Embolism: A Case Report and Review of the Literature.
abstract: BACKGROUND
  Coronary embolization is potentially a fatal sequela of endocarditis. Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is imperative to consider septic embolism as an etiological factor.
  
  
  METHODS
  Herein, we report a case of ventricular fibrillation and ST-segment depression myocardial infarction occurring in a patient who initially presented with fever and increased urinary frequency. Coronary angiography revealed new 99% occlusion of the left main coronary artery (LMCA). Transesophageal echocardiography showed bioprosthetic aortic valve with an abscess and vegetation. Histologic examination of the embolectomy specimen confirmed the presence of thrombus and Enterococcus faecalis bacteria. Subsequently, the patient was discharged to the skilled nursing facility in a stable condition where he completed 6 weeks of intravenous ampicillin.
  
  
  CONCLUSIONS
  We present a rare case of LMCA embolism due to prosthetic valve endocarditis. The present report also highlights the diagnostic and therapeutic challenges associated with such patients.
authors: Department of Medicine, St. Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Hafeez Ul Hassan
authors: HU
authors: Virk
authors: Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors: Faisal
authors: F
authors: Inayat
authors: Department of Neurology, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Salman
authors: S
authors: Farooq
authors: Department of Medicine, Abington Jefferson Hospital, PA, USA.
authors: Ali Raza
authors: AR
authors: Ghani
authors: Department of Cardiology, Lehigh Valley Hospital, PA, USA.
authors: Ghazi A
authors: GA
authors: Mirrani
authors: Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Muhammed Waqas
authors: MW
authors: Athar
keywords: Coronary artery embolism; enterococcus faecalis; myocardial infarction; prosthetic aortic valve endocarditis