Acute infarction, intracoronary thrombolysis, and primary PTCA in pregnancy

Webber, M. Diane; Halligan, Robert E.; Schumacher, Jim

doi:10.1002/(sici)1097-0304(199709)42:1<38::aid-ccd12>3.3.co;2-q

Cited by 2 publications

(2 citation statements)

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“…Thrombolytics used in the first trimester may interfere with implantation of the placenta and in later stages of pregnancy may result in fetal loss or the onset of premature labour (2 1). However, intracoronary thrombolysis followed by PTCA has been successfully used on at least 2 occasions (21,22). PTCA is not suitable in the early stages of pregnancy due to the risk of radiation damage to the fetus (21).…”

Section: Myocardial Infarction During Pregnancymentioning

confidence: 99%

Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Bagg¹,

Henley²,

MacPherson³

et al. 1999

Aust NZ J Obst Gynaeco

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Section: Myocardial Infarction During Pregnancymentioning

confidence: 99%

Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Bagg¹,

Henley²,

MacPherson³

et al. 1999

Aust NZ J Obst Gynaeco

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“…Both findings are consistent with embolus of thrombus. 5 In our opinion, this occlusion was caused by a paradoxical embolus coming from the venous system. Indeed, pregnancy is associated with a fourfold increased risk of venous thrombosis.…”

Section: Discussionmentioning

confidence: 84%

Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman

Agostoni

Gasparini

Destro

2004

Heart

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A 19 year old pregnant woman presented to the coronary care unit with an acute anterior myocardial infarction. She was treated with primary percutaneous transluminal coronary angioplasty of the proximal left anterior descending coronary artery. Ultrasound examination showed patent foramen ovale (PFO) and atrial septal aneurysm. The patient was a heterozygote carrier of factor V Leiden. Despite the lack of a clear clue, it was considered that the pathophysiological cause of this infarction was a paradoxical embolus in the left coronary artery. Pregnancy and factor V Leiden carriership are associated with increased risk of venous thromboembolism and the association between PFO and atrial septal aneurysm is a strong risk factor for systemic embolisation.A 19 year old white woman was admitted to our coronary care unit for an acute myocardial infarction, with two hours' delay from the onset of chest pain. The standard ECG showed ST segment elevation in the anterolateral leads. The only cardiovascular risk factor was cigarette smoking. She reported no drug misuse. She noted she had not had menses for several months, without taking oral contraceptives. A diagnostic test for pregnancy was positive (serum b human chorionic gonadotropin . 10000 UI/l).The patient was immediately moved to the cardiac catheterisation laboratory for primary percutaneous transluminal coronary angioplasty (PTCA). Shielding was placed on the abdomen to protect the fetus from radiation. Coronary angiography showed complete occlusion of the left anterior descending coronary artery (LAD) in its proximal tract ( fig 1A) The other coronary arteries were normal. After crossing the occlusion with a soft guidewire, primary PTCA of the LAD was performed with an optimal result (no residual stenosis and TIMI (thrombolysis in myocardial infarction) grade 3 flow). No ''dog bone'' effect was noted during the inflation of the balloon and, besides the occlusion, the LAD had no signs of atherosclerosis. However, the control angiogram showed that an important first diagonal branch, originating after the occlusion of the LAD, was occluded; it was treated with PTCA, achieving a good final result ( fig 1B) The creatine kinase MB fraction peak was 655 ng/ml in the seventh hour. An echocardiogram, executed in the coronary care unit, showed akinesis of the septum, anterior wall, and apex; ejection fraction was 38%; and an atrial septal aneurysm was present with clear evidence of a patent foramen ovale (PFO) with left to right shunt.An ultrasound abdominal evaluation showed that the gestational age of the fetus was approximately 22 weeks. A diagnostic investigation for a hypercoagulable state examined antithrombin III, proteins C and S, prothrombin time, partial thromboplastin time, fibrinogen and homocysteine concentrations, cardiolipin antibodies, and genotype analysis for factor II and factor V Leiden. All were within normal limits apart from heterozygosis for factor V Leiden mutation. The patient was discharged in good clinical condition and had an uneventful delive...

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Acute infarction, intracoronary thrombolysis, and primary PTCA in pregnancy

Cited by 2 publications

References 0 publications

Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman

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