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Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction: Desperate Times Call for

Mark J Larralde1, Ashwad Afzal, Sorin J Brener

  • 11Department of Internal Medicine, New York Methodist Hospital, Brooklyn, NY; and 2Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, NY.

American Journal of Therapeutics
|July 28, 2015
PubMed

Insights

Nonatherosclerotic embolism causing ST-elevation myocardial infarction (STEMI) is rare, especially in patients with mechanical heart valves. A Fogarty maneuver successfully removed a coronary thrombus when other methods failed, restoring blood flow.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Nonatherosclerotic embolism is an uncommon cause of ST-elevation myocardial infarction (STEMI), accounting for 4%-7% of cases.
  • Prosthetic valve dysfunction and inadequate anticoagulation are significant risk factors for embolic events in the coronary arteries.

Observation:

  • A 56-year-old woman with rheumatic heart disease and three mechanical valves presented with acute anterior STEMI and heart failure.
  • Coronary angiography revealed a left anterior descending artery occlusion with a meniscus sign, suggestive of embolic origin.
  • Initial attempts at thrombus aspiration and balloon angioplasty were unsuccessful in restoring coronary blood flow.

Findings:

  • A Fogarty maneuver successfully extracted the coronary thrombus, achieving Thrombolysis in Myocardial Infarction flow grade 3.
  • The procedure resulted in near-normal myocardial blush and rapid resolution of heart failure symptoms.

Implications:

  • The Fogarty maneuver is a viable and effective treatment option for coronary artery embolism in patients with mechanical heart valves when standard therapies fail.
  • This case highlights the importance of considering nonatherosclerotic embolism in STEMI patients with prosthetic valves and suboptimal anticoagulation.
  • Successful management can lead to rapid clinical improvement and favorable cardiac outcomes.

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