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Endocardial fibroelastosis with coronary artery thromboembolus and myocardial infarction
K L Lane1, A J Herzberg, K A Reimer
1Department of Pathology, Duke University Medical Center, Durham, North Carolina.
Insights
Endocardial fibroelastosis can lead to unusual thromboembolic complications, such as myocardial infarction in pediatric patients. This case highlights the importance of suspecting coronary artery thromboemboli in children with cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Pathology
Background:
- Congenital heart conditions in infants can present with severe symptoms like congestive heart failure and respiratory distress.
- Early life febrile illness in the mother may be a risk factor for fetal cardiac anomalies.
Observation:
- An 18-month-old male presented with symptoms suggestive of cardiomyopathy and myocarditis, initially responding to pharmacologic therapy.
- The patient later experienced respiratory distress and cardiogenic shock, with electrocardiographic (ECG) evidence of myocardial infarction.
Findings:
- Autopsy revealed endocardial fibroelastosis with left ventricular mural thrombi.
- Thromboembolism to the left anterior descending coronary artery resulted in transmural myocardial infarction.
Implications:
- Myocardial infarction is an uncommon but serious thromboembolic complication of endocardial fibroelastosis.
- Pediatric patients with cardiomyopathy and suspected myocardial infarction require a high index of suspicion for coronary artery thromboemboli.
Abstract:
We report a case of an 18-month-old male, born to a woman with third trimester febrile illness, who had a history of congestive heart failure and respiratory distress, cardiomegaly, and electrocardiographic (ECG) findings suggestive of cardiomyopathy and myocarditis. After gradual improvement in heart size and function with pharmacologic therapy, he developed a terminal episode of respiratory distress and cardiogenic shock, with ECG findings of an anterolateral infarct. At autopsy it was found that endocardial fibroelastosis with mural thrombi in the left ventricle had been complicated by thromboembolism to the left anterior descending coronary artery, resulting in transmural infarction of the anteroseptal region of the left ventricle. Myocardial infarction is a potential but unusual thromboembolic complication of endocardial fibroelastosis. A high index of suspicion for coronary artery thromboemboli should be maintained in pediatric patients with cardiomyopathy and suspected myocardial infarction.