Neonatal Acute Myocardial Infarction of Unknown Etiology Treated with Surgical Thrombectomy

Abstract

Coronary artery thrombosis and resultant myocardial infarction in neonates are exceedingly rare. Seldom does a neonate survive this myocardial insult. Often there is an underlying predisposition to coronary artery thrombosis, such as thrombophilia, central line placement, or myocarditis. Treatment attempts have consisted of thrombolysis and supportive care. We present a case of acute left main coronary artery (LMCA) thrombosis of unknown etiology in a neonate, without ventricular dilatation. Flow into the LMCA was suggested echocardiographically, but a high clinical suspicion led to urgent cardiac catheterization. Once complete occlusion of the LMCA was demonstrated angiographically, emergent surgical thrombectomy was performed, which has never previously been reported.

Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

“…A surgical thrombectomy was performed for the first time in a case of left main coronary artery (LMCA) thrombosis which resulted in the death of the neonate. 15 Thrombolysis therapy was performed in two case reports of neonatal myocardial infarction involving thrombosis of the LMCA, however both attempts were unsuccessful and the patients died. 8,9 ECMO support without thrombolysis therapy was successfully used in a neonate with myocardial infarction due to occlusion of the ramus intermedius branch of the left main coronary artery.…”

“…The survival of neonates with coronary artery thrombosis is variable, and available treatments have shown mixed results (Table ). A surgical thrombectomy was performed for the first time in a case of left main coronary artery (LMCA) thrombosis which resulted in the death of the neonate . Thrombolysis therapy was performed in two case reports of neonatal myocardial infarction involving thrombosis of the LMCA, however both attempts were unsuccessful and the patients died .…”

Surgical Management of Extensive Perinatal Myocardial Infarction

“…A variety of management strategies have been offered, with poor prognosis: conservative management, local and systemic thrombolysis, surgical thrombectomy, and circulatory support [3][4][5][6]. Any form of thrombolysis and cardiac catheterization was excluded in our patient because of hemodynamic instability and the threatening size and position of the thrombus in the aortic root.…”

A case of neonatal myocardial infarction: left coronary artery thrombus resolution and normalisation of ventricular function by intracoronary low-dose tissue plasminogen activator

“…Surgical thrombectomy with left ventricular assist device support has also been reported. 3 The use of thrombolytic therapy in the management of neonatal myocardial infarction is controversial and not well established, but it has been used successfully in rare reported cases. 4,5 We used local tissue plasminogen activator at a dose several folds lower than had been previously reported, with subsequent thrombus resolution, normalisation of ventricular function by 4 weeks of age, no neurological sequelae, and no utilisation of extracorporeal membrane oxygenation support.…”

“…, 2 Treatment strategies are sparse, including extracorporeal membrane oxygenation and supportive care. Surgical thrombectomy with left ventricular assist device support has also been reported 3 . The use of thrombolytic therapy in the management of neonatal myocardial infarction is controversial and not well established, but it has been used successfully in rare reported cases 4 …”