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[Myocardial infarction in an infant without coronary artery birth anomalies]
Insights
Neonatal myocardial infarction is typically caused by anomalous coronary arteries. This case highlights successful surgical treatment of mechanical complications in a child with normal coronary arteries, despite an uncertain infarction cause.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Neonatal Medicine
Background:
- Anomalous origin of the left coronary artery is the primary cause of neonatal myocardial infarction.
- Rare causes are considered when coronary angiography reveals a normal coronary tree.
Observation:
- An 18-month-old premature infant presented with myocardial infarction and drug-resistant congestive cardiac failure.
- Angiography revealed a normal coronary tree, severe mitral incompetence, and a left ventricular aneurysm.
Findings:
- Surgical intervention successfully treated the mechanical complications of the myocardial infarction.
- The patient experienced a good outcome 2 years postoperatively without coronary revascularization.
Implications:
- This case demonstrates that surgical treatment of myocardial infarction complications in children with normal coronary arteries is feasible.
- It underscores the importance of considering diverse etiologies for myocardial infarction in neonates, including embolism, thrombosis, blood disorders, infection, and birth-related cardiorespiratory failure.
Abstract:
The anomalous origin of the left coronary artery is almost the only cause of neonatal myocardial infarction. Other rare causes have been proposed when haemodynamic studies have shown a normal coronary tree. An 18 months old child, born prematurely at the 6th month of pregnancy (in a moribund condition), presented with a postero lateral myocardial infarction and congestive cardiac failure resistant to drug therapy. Angiography showed anormal coronary tree, massive mitral incompetence and a left ventricular aneurysm. The mechanical complications of the infarct were treated surgically with a good result, 2 years postoperatively. The possible aetiologies of the infarction are discussed: embolism, thrombosis, blood disorder, infection, and cardiorespiratory failure at birth in a premature baby. This case shows that the complications of myocardial infarction in childhood may be treated surgically without coronary revascularisation when the coronary arteries are normal. The exact cause of the infarction remain uncertain.