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Case Reports
. 2022 Aug 3;4(15):945-949.
doi: 10.1016/j.jaccas.2022.05.031.

Successful Intervention for a Thrombosed Giant Coronary Artery Aneurysm in Multisystem Inflammatory Syndrome in Children

Timothy Stidham  1 , James McKee  2 , Joshua Vogt  1 , Austine Kuder Siomos  3
Affiliations
Case Reports

Successful Intervention for a Thrombosed Giant Coronary Artery Aneurysm in Multisystem Inflammatory Syndrome in Children

Timothy Stidham et al. JACC Case Rep. .

Abstract

We report the case of a 13-year-old who presented with an ST-segment elevation myocardial infarction caused by a thrombotic occlusion of an aneurysmal left anterior descending coronary artery. Our patient was diagnosed and treated for multisystem inflammatory syndrome in children and underwent successful balloon angioplasty and aspiration thrombectomy.(Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; ECG, electrocardiogram; LAD, left anterior descending coronary artery; MI, myocardial infarction; MIS-C, multisystem inflammatory syndrome in children; RCA, right coronary artery; STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombolysis In Myocardial Infarction; acute heart failure; anticoagulation; antiplatelet; myocardial infarction; percutaneous coronary intervention; thrombosis.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Troponin Trend Troponin values from presentation until the patient stabilized. The time on the x axis is in hours. The troponin on the y axis is in nanograms per milliliter. The upper limit of normal for troponin using this scale is 0.012 ng/mL. The arrow delineates the time at which patient underwent catheter intervention.
Figure 2
Figure 2
Presenting Electrocardiogram Electrocardiogram on admission to the pediatric intensive care unit demonstrating ST-segment elevation in leads I and aVL and ST-segment depression in II, III, aVF, V3, and V4.
Figure 3
Figure 3
Coronary Angiograms Selective left coronary artery angiogram using a 6-F catheter in the caudal projection (top left), demonstrating acute occlusion of the proximal left anterior descending coronary artery; selective right coronary artery angiogram using a JR4 5-F catheter (top right). Post-balloon angioplasty and aspiration thrombectomy left coronary artery in the caudal projection with a 6-F catheter (bottom right) and cranial projection (bottom left). There is dilation of the left main coronary artery, proximal, and mid-left anterior descending coronary artery with early aneurysm formation in the mid-left circumflex coronary artery.
Figure 4
Figure 4
Electrocardiogram Demonstrating Final Infarct Pattern Electrocardiogram on discharge demonstrating sinus rhythm with T-wave inversion in I and aVL (orange arrows), Q waves in V1 to V3(blue arrows), consistent with an anteroseptal infarct.
Figure 5
Figure 5
Cardiac Magnetic Resonance Image Magnetic resonance image 4 months from myocardial infarction without and with intravenous gadolinium. (A) Short axis left ventricle at the level of the papillary muscles. (B) Apical short axis of the left ventricle. (C) Four-chamber; delayed subendocardial enhancement involving the anterior wall and anterior septum of the left ventricle, spanning basal to apical segments.
See this image and copyright information in PMC

References

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