title: Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction: Desperate Times Call for Desperate Measures.
abstract: Nonatherosclerotic embolism is a rare cause (4%-7%) of coronary occlusion in ST-segment elevation myocardial infarction (STEMI) patients, approximately half of which occur in inadequately anticoagulated patients with prosthetic valves. We report a rare case of a patient with severe rheumatic heart disease and 3 mechanical valves presenting with STEMI that was successfully managed by Fogarty maneuver thrombus extraction after failed thrombus aspiration and balloon angioplasty. A 56-year-old woman presented with an acute anterior STEMI and Killip class III heart failure. She had severe rheumatic heart disease with mechanical tricuspid, mitral and aortic valve prostheses, and atrial fibrillation on warfarin anticoagulation. The international normalized ratio on admission was 1.1. Emergency coronary angiography revealed normal right and circumflex coronary arteries and a total occlusion in the mid left anterior descending artery with a meniscus appearance. Multiple attempts at thrombus aspiration and balloon angioplasty failed to restore flow in the left anterior descending artery. Ultimately, a Fogarty maneuver using a compliant balloon inflated at a low pressure was performed successfully, removing the thrombus into the guiding catheter. There was Thrombolysis in Myocardial Infarction flow grade 3 and near-normal myocardial blush at the end of the procedure. Signs and symptoms of heart failure resolved quickly.
authors.affiliation: 1Department of Internal Medicine, New York Methodist Hospital, Brooklyn, NY; and 2Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, NY.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Larralde
authors.forename: Ashwad
authors.initials: A
authors.lastname: Afzal
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy; D063125:Balloon Embolectomy / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000209:etiology / Q000628:therapy*; D004617:Embolism / Q000150:complications / Q000628:therapy*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000150:complications; D000072657:ST Elevation Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin