Infected coronary artery pseudoaneurysm after repeated percutaneous coronary intervention

Coronary stent infection is exceedingly rare, with only 23 reported cases. We present a patient with an everolimus-coated stent infection that led to an infected pseudoaneurysm in the left anterior descending artery. Medical therapy failed and the patient underwent emergent surgical intervention; however, he died of multiorgan failure after the operation.     

Spontaneous coronary artery dissection in Ehlers-Danlos syndrome

Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders with type IV, the vascular subtype, behaving as the most severe largely due to spontaneous arterial aneurysm and dissection. In this case report we describe a spontaneous left anterior descending coronary artery dissection treated with coronary artery bypass graft in a patient with Ehlers-Danlos syndrome type IV.     

Successful on-pump coronary artery bypass without using protamine

A 48-year-old woman presented with a history of angina and breathlessness on exertion. She was diagnosed to have critical left main stem coronary artery disease along with a blocked right coronary artery. She was also allergic to protamine. After multidisciplinary consultation, it was decided to use heparin without protamine for reversal. She underwent successful on-pump coronary artery bypass grafting (CABG) without excessive blood loss. The disadvantages were a longer total operating time and the use of blood products to achieve normal coagulation. This case report describes the successful management of this complex problem.     

Left ventricular rupture during off-pump coronary artery bypass grafting

Left ventricular rupture is a highly lethal, but rare, complication of myocardial infarction. We report the first case of a postinfarction, intraoperative left ventricular apical rupture during an off-pump coronary artery bypass grafting due to the application of apical suction used to expose target vessels.     

Breast infarction due to calciphylaxis after coronary artery bypass grafting

The use of the internal mammary artery for coronary artery bypass grafting is common. We describe a patient with chronic renal insufficiency who had no need for dialysis, and who suffered from breast necrosis after coronary artery bypass grafting with internal mammary artery harvesting due to calciphylaxis. The histology report of the breast tissue showed mural vascular calcification and intima proliferation of small-sized to medium-sized vessels. This causes ischemic necrosis of the skin and septal panniculitis. We believe that this is the first case report of breast necrosis after coronary artery bypass grafting, due to calciphylaxis in a patient with known chronic renal insufficiency, without renal replacement therapy.