Survival following non-operative management of infected coronary artery aneurysm with infected pericardial effusion complicated by multi-organ failure: a case report

Background Infected coronary artery aneurysm with infected pericardial effusion is a very rare complication following percutaneous coronary intervention (PCI) and is associated with high mortality. Management options include open cardiothoracic surgery or non-operative management with pericardiocentesis. The best management option is currently unknown. Case summary A 76-year-old man with a background of hypertension, type two diabetes mellitus, chronic kidney disease, and a pacemaker presented with worsening shortness of breath 5 weeks following PCI to the right coronary artery (RCA) for a non-ST elevation myocardial infarction. His blood cultures grew methicillin-sensitive Staphylococcus aureus and he developed progressive renal failure and shortness of breath despite high-dose antibiotics. Echocardiography showed a pericardial effusion with impending tamponade and the patient proceeded urgently for pericardiocentesis. He subsequently developed severe cardiogenic and vasoplegic shock with multi-organ failure. Computed tomography coronary angiography (CTCA) showed an RCA aneurysm. He was conservatively managed with a pericardial window due to being too high risk for cardiac surgery and subsequently made a full recovery. Discussion Non-operative management of infected coronary artery aneurysm and infected pericardial effusion resulted in survival and return to baseline function in our patient despite the development of severe shock with multi-organ failure.