Acute myocardial infarction in a child: possible pathogenic role of patent foramen ovale associated with heritable thrombophilia.
We report an 8-year-old girl who presented with clinical features of an acute myocardial infarction. The angiographic appearance of the coronary arteries was normal. A thrombophilic state caused by a homozygote genotype for the prothrombin G20210A mutation was detected, and a patent foramen ovale (PFO) with right-to-left shunting after Valsalva maneuver was demonstrated by transesophageal contrast echocardiography. No other embolic source was identified. We suggest that paradoxical embolization through a PFO resulted in a myocardial infarction in this young patient with hereditary thrombophilia. We closed the patient's PFO with a 25-mm PFO occluder. She was anticoagulated with warfarin for 6 months. After 6 months, a contrast echocardiogram showed no evidence of residual atrial shunt. There has been no evident recurrent paradoxical embolization.
Department of Pediatrics, University of Parma, Parma, Italy.
Nicola
N
Carano
Aldo
A
Agnetti
Donald J
DJ
Hagler
Bertrand
B
Tchana
Umberto
U
Squarcia
Sergio
S
Bernasconi
D002648:Child; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D004617:Embolism / Q000209:etiology; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D009211:Myoglobin / Q000097:blood; D014336:Troponin / Q000097:blood; D014463:Ultrasonography
D007527:Isoenzymes; D009211:Myoglobin; D014336:Troponin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form