Myocardial infarction in an adolescent: anomalous origin of the left main coronary artery from the right coronary sinus in association with combined prothrombotic defects.
We present the case of a 15-year-old boy with clinical features of an acute myocardial infarction. Angiography revealed a complete obstruction of the left main coronary artery. A coronary-aorto-bypass graft was undertaken immediately. Cardiac computed tomography demonstrated an anomalous origin of the left main coronary artery from the right coronary sinus of the aorta. A thrombophilic state with a heterozygote genotype for prothrombin G20210 mutation, a C677T methylenetetrahydrofolate reductase gene mutation, and a protein C type 1 deficiency was detected. No other embolic source could be identified. The patient recovered with persistent left ventricular dysfunction. He is now taking the anticoagulant warfarin. Combined prothrombotic defects in combination with additional risk factors such as coronary anomalies can lead to myocardial infarction even in children and adolescents.
Koestenberger
Martin
M
Department of Pediatrics, Medical University Graz, Auenbruggerplatz 30, A-8036 Graz, Austria. koestenbergerm@gmx.at
Nagel
Bert
B
Gamillscheg
Andreas
A
Temmel
Werner
W
Cvirn
Gerhard
G
Beitzke
Albrecht
A
D000293:Adolescent; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging* / Q000235:genetics; D006801:Humans; D008297:Male; D009154:Mutation; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000235:genetics; D011516:Prothrombin / Q000235:genetics / Q000378:metabolism; D019851:Thrombophilia / Q000150:complications / Q000000981:diagnostic imaging* / Q000235:genetics; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000235:genetics
D011516:Prothrombin