title: Successful primary percutaneous coronary intervention in the first trimester of pregnancy.
abstract: A 28-year-old patient, medical nurse, in 10th week of her second pregnancy suffered ventricular fibrillation just after entering the waiting room of the emergency department. After she was successfully defibrillated, electrocardiography revealed a large acute anteroseptolateral ST elevation myocardial infarction. Urgent coronarography was done (premedication with 300 mg of aspirin and 600 mg of clopidogrel) with 90 min door-to-balloon time. Proximal left anterior descending occlusion was found, primary percutaneous coronary intervention was done using Amazonia CroCo 3.0/12 bare-metal stent, and Thrombolysis in Myocardial Infarction III flow was achieved. During the procedure, the patient was wrapped in lead apron. Because of postresuscitational agitation, procedure was done in intravenous anesthesia. The revealed risk factors were smoking and hypercholesterolemia. PAI-1 gene 4G/4G genotype and Apo E gene E2/E4 genotype were also found. Estimated X-ray dosage that fetus received during the procedure was 0.45 mSv, which is less than the upper safe limit in pregnancy. All drugs given to our patient (clopidogrel, aspirin, ivabradine, bisoprolol, anesthetics, low-molecular-weight heparin, and unfractionated heparin) have B or C Food and Drug Administration Pregnancy Category. Fetal ultrasonography showed normal fetal growth, and, after consultation with our team, the patient decided to maintain the pregnancy. Before discharge echocardiography showed left ventricle of normal size with anteroseptolateral hypokinesia, small apical aneurysm, left ventricular ejection fraction of 40-45%, and diastolic dysfunction grade II, without pulmonary hypertension. At the 36th week of pregnancy, the patient was hospitalized and closely monitored; clopidogrel and aspirin were discontinued, and low-molecular-weight heparin was administered. She gave birth to a normal boy by vaginal delivery with epidural anesthesia and without any complication.
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Sestre milosrdnice, Zagreb, Croatia. zbabic@net.hr
authors.forename: Zdravko
authors.initials: Z
authors.lastname: Babic
authors.forename: Ivo Darko
authors.initials: ID
authors.lastname: Gabric
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Pintaric
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000628:therapy*; D011261:Pregnancy Trimester, First; D011829:Radiation Dosage; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014693:Ventricular Fibrillation / Q000628:therapy
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors