Microvascular obstruction complicating acute right ventricular myocardial infarction

Area of Science:

• Cardiology
• Cardiovascular Imaging

Background:

• Inferior myocardial infarction (MI) can involve the right ventricle, impacting overall cardiac function.
• Percutaneous coronary intervention with stenting is a primary treatment for acute MI.

Observation:

• A patient with inferior MI and right ventricular involvement presented with left and right ventricular akinesia post-stenting.
• Cardiac magnetic resonance imaging demonstrated left ventricular inferior and inferolateral wall akinesia, and right ventricular inferior free wall akinesia.
• Late gadolinium enhancement (LGE) indicated myocardial infarction and microvascular obstruction (MVO) in both ventricles.

Findings:

• Persistent akinesia of the left ventricular inferior and inferolateral walls and right ventricular systolic dysfunction were noted at follow-up.
• Late gadolinium enhancement (LGE) persisted, signifying myocardial scarring.
• Resolution of microvascular obstruction (MVO) was observed, despite persistent wall motion abnormalities.

Implications:

• This case underscores the utility of cardiac MRI in assessing myocardial damage and microvascular integrity after MI.
• Understanding the extent and persistence of myocardial injury, including MVO, is crucial for prognosis and management.
• Right ventricular involvement in inferior MI can lead to persistent dysfunction, requiring careful monitoring.