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Ahluwalia N, Pass RH, Aydin SI. Newborn With Severely Depressed Left Ventricular Function: Acute Myocardial Infarction in a Newborn. JACC Case Rep 2020; 2:1837-1840. [PMID: 34317063 PMCID: PMC8299252 DOI: 10.1016/j.jaccas.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
We describe a rare case of spontaneous coronary artery thrombosis in a newborn leading to rapid severe ventricular dysfunction. Early diagnosis is critical and management strategies are varied including hemodynamic support with extracorporeal membrane oxygenation, systemic/local thrombolytic therapy with tissue plasminogen activator, or surgical thrombectomy. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Neha Ahluwalia
- Address for correspondence: Dr. Neha Ahluwalia, Mount Sinai Hospital, 1468 Madison Avenue, Annenberg 3, New York, New York 10029.
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Early survival following in utero myocardial infarction. Cardiol Young 2018; 28:1079-1087. [PMID: 30033903 DOI: 10.1017/s1047951118001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrauterine myocardial infarction is a rare and frequently fatal diagnosis. It has been presented in the literature only as case reports and short series. We present a case report of a coronary occlusive intrauterine myocardial infarction and survival and present a systematic review of the literature. This is the first summative description of current data on intrauterine and perinatal myocardial infarction. We performed the systematic review based on the guidelines established by the PRISMA statement. Our population of intrauterine and perinatal myocardial infarction included published cases who presented as a live birth within the first 28 postnatal days, and had a diagnosis of myocardial infarction. We conducted descriptive statistics and regression analysis on short-term mortality as the primary outcome. After applying exclusion criteria we described 84 individual cases of myocardial infarction from 63 full-text articles including our own case. Presentation within the first 12 hours was associated with mortality (OR 3.90, p=0.004). Treatment modalities were varied and inconsistently recorded. The aetiologies and comorbidities are varied in our systematic review. We would have a low threshold to perform viral testing, consider anticoagulation early and coronary imaging if feasible. The use of extracorporeal membranous oxygenation may serve as a bridge to cardiac recovery.
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Papneja K, Chan AK, Mondal TK, Paes B. Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality. Pediatr Cardiol 2017; 38:427-441. [PMID: 28238152 DOI: 10.1007/s00246-016-1556-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/23/2016] [Indexed: 01/24/2023]
Abstract
Coronary artery disease is a global problem with high mortality rates and significant residual sequelae that affect long-term quality of life. Myocardial infarction (MI) in neonates is a recognized, uncommon entity, but the incidence and broad spectrum of the disease is unknown and likely underestimated due to limited reporting which in the majority is confined to acute ischemic events. The challenges involve clinical diagnosis which masquerades in the early phase as non-specific symptoms and signs that are commonly found in a host of neonatal disorders. Precise diagnostic criteria for neonatal MI are lacking, and management is driven by clinical presentation and hemodynamic stabilization rather than an attempt to rapidly establish the root cause of the condition. We conducted a review of the published reports of neonatal MI from 2000 to 2014, to establish an approach to the diagnosis and management based on the existing evidence. The overall evidence from 32 scientific articles stemmed from case reports and case series which were graded as low-to-very low quality. Neonatal MI resembles childhood and adult MI with features that involve characteristic ECG changes, raised biomarkers, and diagnostic imaging, but with lack of robust, standardized criteria to facilitate prompt diagnosis and timely intervention. The mortality rate of neonatal MI ranges from 40 to 50% based on inclusion criteria, but the short-term data reflect normal quality of life in survivors. An algorithm for the diagnosis and management of neonatal MI may optimize outcomes, but at the present time is based on limited evidence. Well-designed clinical studies focusing on the definition, diagnosis, and management of neonatal MI, backed by international consensus guidelines, are needed to alter the prognosis of this serious condition.
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Affiliation(s)
- Koyelle Papneja
- Division of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anthony K Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Tapas K Mondal
- Division of Cardiology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Bosco Paes
- Division of Neonatology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. .,Department of Pediatrics, McMaster University, Room HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Abstract
Background Infant and neonatal myocardial infarction (MI) has been described in association with congenital heart disease, coronary artery abnormalities, myocarditis, and tumors. MI in the perinatal period in a structurally normal heart and with ventricular arrhythmia as a presenting feature has not been thoroughly described. Published case reports describe treatment methods extrapolated from adult MI. However, due to the rare occurrence, the most appropriate acute treatment for both MI and ventricular arrhythmia in newborn infants remains unknown. Case A male term infant with perinatal asphyxia and need for extensive cardiopulmonary resuscitation at birth had ventricular tachyarrhythmia and ST-elevations on electrocardiogram. Four hours after birth, he died from cardiogenic failure. A thrombus at the right coronary artery was found on autopsy. Conclusion MI in the perinatal period in a structurally normal heart is very rare and mortality is high. Although acute treatments extrapolated from adult MI has been described to result in favorable outcomes in newborn infants, guidelines are lacking on how to manage acute MI and associated ventricular arrhythmia.
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Affiliation(s)
- Anne Lee Solevåg
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Intensive Care Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Intensive Care Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Intensive Care Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Ham PB, Patel P, Wise LJ, Walters C, Stansfield BK. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hunter BR, Caton T. Fatal infant myocardial infarction caused by ball-IN-valve mechanism from a dysplastic aortic valve. J Emerg Med 2013; 45:e201-e204. [PMID: 23937812 DOI: 10.1016/j.jemermed.2013.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 03/02/2013] [Accepted: 04/30/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Acute myocardial infarction (AMI) can occur in infants. Early identification of AMI can allow for specific therapies aimed at improving patient outcomes. OBJECTIVE This article describes a case of an infant with AMI caused by a previously unreported mechanism and reviews diagnostic and therapeutic strategies for dealing with this rare disease. CASE REPORT We present a case of a 5-week-old infant with a fatal AMI due to a pedunculated nodule from a dysplastic aortic valve leaflet creating a ball-in-valve mechanism and occluding the left main coronary artery. CONCLUSION AMI is an important diagnostic consideration in any infant presenting with signs of unexplained cardiogenic shock. Practitioners who care for children should be aware of diagnostic and therapeutic strategies for AMI in infants.
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Affiliation(s)
- Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Deutsch MA, Cleuziou J, Noebauer C, Eicken A, Vogt M, Hoerer J, Lange R, Schreiber C. Successful management of neonatal myocardial infarction with ECMO and intracoronary r-tPA lysis. CONGENIT HEART DIS 2013; 9:E169-74. [PMID: 23809294 DOI: 10.1111/chd.12117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/30/2022]
Abstract
Acute myocardial infarction (MI) is a life-threatening condition rarely encountered in neonates. The patients usually present with sudden cardiogenic shock. Clinical management in neonates is extremely challenging. If treatment is delayed, the prognosis is dismal. We report on a 4-day-old full-term male newborn presenting with acute MI and cardiogenic shock secondary to proximal thromboembolic occlusion of the left descending coronary artery. Hemodynamic stabilization could only be achieved after extracorporeal membrane oxygenation (ECMO) support. Coronary artery patency restoration was performed by selective intracoronary lysis with recombinant tissue plasminogen activator (r-tPA). ECMO support could be discontinued and myocardial function recovered within 6 weeks. We discuss the potential etiologies of acute perinatal MI and the role of ECMO support in the immediate post-MI period. Prompt recognition, timely referral to a cardiac center with availability of specialized advanced treatment options, and management in an orchestrated interdisciplinary approach are crucial for achieving a good outcome.
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Affiliation(s)
- Marcus-André Deutsch
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany
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Farooqi KM, Sutton N, Weinstein S, Menegus M, Spindola-Franco H, Pass RH. Neonatal myocardial infarction: case report and review of the literature. CONGENIT HEART DIS 2012; 7:E97-102. [PMID: 22537076 DOI: 10.1111/j.1747-0803.2012.00660.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myocardial infarction in a neonate is rare. We describe the case of a full-term male who presented with respiratory distress. A chest radiograph demonstrated cardiomegaly. An electrocardiogram revealed ST segment changes suggestive of ischemia. Cardiac enzymes were elevated and an echocardiogram revealed a regional wall motion abnormality. Cardiac catheterization was performed demonstrating occlusion of the ramus intermedius branch of the left main coronary artery. The patient decompensated, requiring extracorporeal membrane oxygenation (ECMO). The infant was able to be decannulated from ECMO support in 5 days and was ultimately discharged on hospital day 25. We review this case as well as the literature on neonatal myocardial infarction.
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Affiliation(s)
- Kanwal M Farooqi
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Bronx, NY 10467, USA.
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de Vetten L, Bergman KA, Elzenga NJ, van Melle JP, Timmer A, Bartelds B. Neonatal myocardial infarction or myocarditis? Pediatr Cardiol 2011; 32:492-7. [PMID: 21212943 PMCID: PMC3061208 DOI: 10.1007/s00246-010-9865-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/07/2010] [Indexed: 11/27/2022]
Abstract
We report a 29 week-gestation preterm infant who presented during his second week of life with cardiogenic shock. Clinical presentation and first diagnostics suggested myocardial infarction, but echocardiographic features during follow-up pointed to a diagnosis of enteroviral myocarditis. The child died of chronic heart failure at 9 months of age. Autopsy showed passed myocardial infarction. No signs for active myocarditis were found. We discuss the difficulties in differentiating between neonatal myocardial infarction and myocarditis. Recognizing enteroviral myocarditis as cause for cardiogenic shock is of importance because of the therapeutic options.
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Affiliation(s)
- Leanne de Vetten
- Department of Neonatology, University Medical Centre Groningen, Hanzeplein 1, P. O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Abstract
We extracted L., the newborn of a diabetic mother, for antenatal diagnostic of myocardial hypertrophy and anomaly of foetal heart rate. Post-natal echocardiography showed severe septal myocardial hypertrophy with latero-basal myocardial akinesia. We did not observe a Doppler gradient through the left ventricular outflow. Selective coronary angiography showed an occlusion of the circumflex artery. Myocardial hypertrophy is a classic complication in newborns of diabetic mothers. The mother's diabetes and neonatal infarction remain an exceptional association. We discuss a different hypothesis to explain coronary occlusion and how myocardial infarction avoided septal obstruction.
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