ST segment elevation myocardial infarction of a rare aetiology: an unexpected diagnosis

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Acute coronary syndrome with ST-segment elevation myocardial infarction (STEMI) necessitates urgent intervention.
• Coronary artery obstruction can arise from various causes, including external compression.
• Congenital cardiac anomalies are rare but critical differential diagnoses in cardiovascular emergencies.

Observation:

• A 43-year-old male presented with STEMI, revealing dynamic obstruction in the left coronary circulation during angiography.
• Initial thrombectomy and balloon angioplasty for left anterior descending and diagonal artery lesions were unsuccessful.
• Cardiac CT identified a circumferential groove compressing coronary arteries, suggesting external etiology.

Findings:

• Congenital cardiac hernia was diagnosed as the cause of external coronary artery compression and STEMI.
• Thoracoscopy confirmed the cardiac hernia and an associated fibrous pericardial band constricting the cardiac apex.
• Surgical release of the constriction via left mini-thoracotomy restored coronary circulation.

Implications:

• This case highlights congenital cardiac hernia as a rare but treatable cause of acute coronary syndrome.
• Early diagnosis through advanced imaging (Cardiac CT) is crucial for identifying external compression etiologies.
• Surgical intervention can effectively relieve coronary obstruction caused by cardiac hernia, improving patient outcomes.