title: Embolic myocardial infarction in a patient with a Fontan circulation.
abstract: Coronary artery embolism is an uncommon cause of acute myocardial infarction (MI). We present a patient with pulmonary atresia and severe right heart hypoplasia who underwent a lateral tunnel Fontan procedure in childhood and presented with an acute ST-segment elevation MI at 19 years of age. In addition to the known risk of thrombotic complications associated with a Fontan circulation, potential predisposing factors to thromboembolism in this patient included a right ventricle to left anterior descending coronary connection and a Fontan baffle leak. The patient was treated with device closure of the baffle leak and anticoagulation. This is one of the first reports of an embolic MI in a patient with a Fontan circulation. The optimal method of reducing thromboembolic risk in this patient, and those with a Fontan circulation in general, is complicated and no consensus exists.
authors.affiliation: Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA Ramin.Hastings@nyumc.org.
authors.forename: Ramin S
authors.initials: RS
authors.lastname: Hastings
authors.affiliation: Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Muhamed
authors.initials: M
authors.lastname: Saric
authors.affiliation: Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Calvin
authors.initials: C
authors.lastname: Ngai
authors.affiliation: Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Skolnick
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D018633:Pulmonary Atresia / Q000150:complications / Q000601:surgery; D017131:Thrombectomy; D013923:Thromboembolism / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Fontan; embolism; myocardial infarction; tricuspid atresia