A Rare Case of Embolic ST-Elevation Myocardial Infarction in an Adult Patient With Repaired Hypoplastic Left Heart Syndrome.
A 24-year-old male with past medical history of hypoplastic left heart syndrome and staged reconstructive surgery in infancy culminating in the Fontan circulation presented to the hospital with a chief complaint of chest pain described as an "elephant sitting" on his chest. Initial 12-lead electrocardiogram revealed 2-mm ST segment elevation in inferior leads, 3-mm ST-segment elevation in anterolateral precordial leads V3 and V4, and 2-mm ST-segment elevation in V5 and V6, with right axis deviation. He was transported emergently to the cardiac catheterization laboratory where coronary angiography revealed complete occlusion of multiple anomalous branches of the right coronary system with hazy appearance suggesting the presence of thrombotic material. An aspiration catheter was used successfully to reestablish TIMI grade III flow. The patient was treated with aspirin, brilinta (ticagrelor), and anticoagulation with vitamin K antagonism to prevent recurrent thromboembolic complications.
1 Department of Medicine, St. Joseph Medical Center, New York Medical College, Patterson, NJ, USA.
Razan
R
Shamoon
2 Department of Cardiology, St. Joseph Medical Center, New York Medical College, Patterson, NJ, USA.
Habib
H
Habib
3 Department of Cardiology, Trinitas Regional Medical Center, Seton Hall University, Elizabeth, NJ, USA.
Upamanyu
U
Rampal
2 Department of Cardiology, St. Joseph Medical Center, New York Medical College, Patterson, NJ, USA.
Aiman
A
Hamdan
2 Department of Cardiology, St. Joseph Medical Center, New York Medical College, Patterson, NJ, USA.
Mahesh
M
Bikkina
2 Department of Cardiology, St. Joseph Medical Center, New York Medical College, Patterson, NJ, USA.
Fayez
F
Shamoon
D000328:Adult; D017023:Coronary Angiography; D004562:Electrocardiography; D004617:Embolism / Q000150:complications* / Q000175:diagnosis; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D012086:Reoperation; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
Fontan; adult congenital heart disease; angioplasty; coronary artery anomaly; embolism; hypoplastic left heart syndrome; myocardial infarction