Neonatal Myocardial Infarction: Case Report and Review of the Literature

Farooqi, Kanwal M.; Sutton, Nicole; Weinstein, Samuel; Menegus, Mark; Spindola‐Franco, Hugo; Pass, Robert H.

doi:10.1111/j.1747-0803.2012.00660.x

Cited by 32 publications

(32 citation statements)

References 28 publications

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“…Neonates with high pulmonary vascular resistance may be especially prone to this pathomechanism because of right–left shunting. Associations between MI and umbilical vein catheterization have also been reported …”

Section: Discussionmentioning

confidence: 87%

Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r-tPA lysis

et al. 2013

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Acute myocardial infarction (MI) is a life-threatening condition rarely encountered in neonates. The patients usually present with sudden cardiogenic shock. Clinical management in neonates is extremely challenging. If treatment is delayed, the prognosis is dismal. We report on a 4-day-old full-term male newborn presenting with acute MI and cardiogenic shock secondary to proximal thromboembolic occlusion of the left descending coronary artery. Hemodynamic stabilization could only be achieved after extracorporeal membrane oxygenation (ECMO) support. Coronary artery patency restoration was performed by selective intracoronary lysis with recombinant tissue plasminogen activator (r-tPA). ECMO support could be discontinued and myocardial function recovered within 6 weeks. We discuss the potential etiologies of acute perinatal MI and the role of ECMO support in the immediate post-MI period. Prompt recognition, timely referral to a cardiac center with availability of specialized advanced treatment options, and management in an orchestrated interdisciplinary approach are crucial for achieving a good outcome.

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Section: Discussionmentioning

confidence: 87%

Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r-tPA lysis

et al. 2013

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“…Of note, a few case reports have been published describing patients having MI in the neonatal period without structural heart disease. [26][27][28][29][30][31][32] All reported newborns with documented MI that survived the acute phase apparently recovered their heart function. [26][27][28]31,32 Because reperfusion therapy was successfully performed in our patient, we cannot exclude the phenomena of stunning or hibernation contributing to the profound cardiac improvements in our patient.…”

Section: Discussionmentioning

confidence: 99%

Functional Recovery of a Human Neonatal Heart After Severe Myocardial Infarction

Haubner

Schneider

Schweigmann

et al. 2016

Circulation Research

280

195

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Rationale: Cardiac remodeling and subsequent heart failure remain critical issues after myocardial infarction despite improved treatment and reperfusion strategies. Recently, cardiac regeneration has been demonstrated in fish and newborn mice after apex resection or cardiac infarctions. Two key issues remain to translate findings in model organisms to future therapies in humans: what is the mechanism and can cardiac regeneration indeed occur in newborn humans?Objective: To assess whether human neonatal hearts can functionally recover after myocardial infarction. Methods and Results: Here, we report the case of a newborn child having a severe myocardial infarction due to coronary artery occlusion. The child developed massive cardiac damage as defined by serum markers for cardiomyocyte cell death, electrocardiograms, echocardiography, and cardiac angiography. Remarkably, within weeks after the initial ischemic insult, we observed functional cardiac recovery, which translated into long-term normal heart function. Conclusions:

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“…A summary of these studies is presented in Tables 1 and 2 [8,15e19]. Complete recovery from large and severe myocardial infarctions occurred in a remarkable number of cases [8,15,17,20], which suggests that ECMO may provide myocardial support and promote recovery in non-infarcted areas. Mortality in a single case report was associated with a serum Troponin I of 10.5 ng/mL [19], while an intact survivor supported with ECMO had an initial serum troponin value of 24.72 ng/mL [8].…”

Section: Discussionmentioning

confidence: 99%

Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

Ham

Patel

Wise

et al. 2015

Journal of Pediatric Surgery Case Reports

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a b s t r a c tPerinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO) and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn. Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Perinatal asphyxia is a common cause of morbidity and mortality in the newborn period with an incidence between 0.5 and 2% [1,2]. The newborn myocardium is preferentially spared during the early phase of newborn hypoxemia; however, evidence of myocardial injury is present in 29e78% of newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) [3e5]. Global oxygen deprivation, which is suggested by a 5 min Apgar score less than 7, underlies the pathogenesis of myocardial injury in the newborn period [6,7]. Additionally, biomarkers of myocardial injury (i.e. troponin and CK-MB), echocardiographic abnormalities, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality [7]. We present a case of an infant who developed severe myocardial dysfunction following emergent Caesarian delivery for fetal decelarations and was managed with extracorporeal membrane oxygenation (ECMO). We discuss the role of cardiac biomarkers, echocardiography, electrocardiography (ECG), and ECMO in the asphyxiated newborn. Case presentationA 22-year-old G 1 P 0 mother presented to a regional hospital with symptoms of labor at 35 weeks gestation. The perinatal history was significant for insulin-dependent diabetes mellitus and chronic hypertension. A normal anatomic ultrasound was noted, however fetal echocardiography was not performed. Following a trial of labor and poor progression, late decelerations were noted and the infant was delivered by Caesarian section. Upon delivery, the 2,700 g infant appeared floppy without spontaneous respiratory effort and persistent bradycardia. Resuscitative efforts in the delivery room included intubation, ventilation, chest compressions (15 min), multiple fluid boluses, and epinephrine. APGAR scores were 1, 3, and 5 at 1, 5, and 10 min, respectively and an initial arterial blood gas provided evidence of severe metabolic acidosis with a pH of 6.81 and base deficit of À23. The patient was transferred to the in-hospital Level III NICU and was noted to have spontaneous respirations and movement with significant hypoxemia (70e80% saturations on FiO2 of 1.0). However, the patient experienced prolonged bradycardia (60e70 b.p.m.) and a corresponding rhythm strip revealed ST segment elevation. A continuous infusion of epinephrine was initiated and the infant was transferred...

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Neonatal Myocardial Infarction: Case Report and Review of the Literature

Cited by 32 publications

References 28 publications

Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r-tPA lysis

Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r-tPA lysis

Functional Recovery of a Human Neonatal Heart After Severe Myocardial Infarction

Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

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