Coronary embolism causing acute myocardial infarction in a patient with mitral valve prosthesis: successful management with angioplasty.
A 24-year-old male patient with anterior myocardial infarction, caused by embolization from mitral valve prosthesis due to inadequate anticoagulation is presented. The patient underwent cardiac catheterization within 90 minutes of arrival. Angiography showed total occlusion of the left anterior descending coronary artery (LAD) after the second diagonal branch. Thrombus was extracted with export catheter from LAD, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transoesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with coronary angiography with clot extraction with aspiration catheter (Export XT 6F Medtronic) only, without stenting.
Sial
Jawaid Akbar
JA
National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Ferman
Mohammad Tariq
MT
Saghir
Tahir
T
Rasool
Syed Ishtiaq
SI
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin