Acute Intraoperative STEMI in a Toddler.

Area of Science:

• Pediatric Cardiology
• Cardiovascular Research
• Rare Pediatric Diseases

Background:

• Coronary artery disease and acute coronary ischemia are exceptionally rare in the pediatric population.
• Children typically do not present with cardiac ischemia, making such cases highly unusual and challenging to diagnose.

Purpose of the Study:

• To report an extremely rare case of acute diffuse coronary ischemia in a toddler.
• To investigate the potential underlying causes and diagnostic findings in a pediatric patient with acute coronary ischemia.

Main Methods:

• Case report of a 22-month-old male with developmental delay and chromosome 1q21.1 microduplication.
• Utilized multimodal diagnostics including electrocardiogram, cardiac troponin levels, echocardiogram, computed tomography, and cardiac catheterization.
• Conducted an extensive workup to rule out infectious, rheumatologic, genetic, and thromboembolic etiologies.

Main Results:

• The toddler presented with refractory hypotension during a urologic procedure under general anesthesia, indicative of acute diffuse coronary ischemia.
• Diagnostic findings revealed electrocardiogram changes, elevated cardiac troponin, impaired cardiac function, and diffuse coronary vasculopathy.
• No definitive infectious, rheumatologic, genetic, or thromboembolic cause was identified for the coronary ischemia or chronic cardiac dysfunction.

Conclusions:

• This case represents an exceptionally rare presentation of acute coronary ischemia in a young child.
• The etiology of the coronary vasculopathy remains unclear, necessitating further investigation into similar pediatric cases.
• Management involved mechanical ventilation, vasoactive support, and eventual transition to oral heart failure medication.