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(Circulation. 2000;101:1219.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Myocardial Infarction in Children With Hypoplastic Coronary Arteries

A. Fraisse, MD; J. Quilici, MD; I. Canavy, MD; B. Savin, MD; F. Aubert, MD; M. Bory, MD

From the Service de Cardiologie A, Hôpital de la Timone, and the Service de Chirurgie thoracique et cardiovasculaire, Hôpital d’enfants de la Timone (F.A.), Marseille, France.

Correspondence to A. Fraisse, MD, Service de Cardiologie A, Hôpital de la Timone, Blvd Jean Moulin, 13385 Marseille Cedex 5, France. E-mail afraisse@ap-hm.fr

An 11-year-old boy with a past history of asthma was admitted to the pediatric intensive care unit (ICU) for a non–Q-wave myocardial infarction that occurred during sustained exercise (a handball match). He presented with chest pain, anterior ST-segment depression on the ECG (Figure 1), and elevation of creatinine kinase (peak, 2580 mU; MB, 240). Initial physical examination was normal, and his ICU course was uncomplicated. He was discharged to the ward after 2 days, and cardiac catheterization was performed 8 days after admission. Left ventriculography (Figure 2) revealed mild apical hypokinesia with an ejection fraction of 55%. Selective coronary arteriography showed no atherosclerotic lesion but hypoplasia of the distal left anterior descending (LAD) and right coronary (RCA) arteries (Figures 3 and 4). There was no supply of the inferior aspect of the interventricular septum by a posterior branch from the RCA or left circumflex coronary artery (LCx). The proximal LAD was normal, with well-developed septal branches but no diagonal branches filled by contrast on the anterolateral free wall of the left ventricle (Figure 4). Intracoronary infusion of nitroglycerin showed no significant changes in coronary artery diameter (Figure 5). Total cholesterol, HDL, sedimentation rate, serological studies for connective-tissue diseases, antithrombin III, protein C, protein S, endogenous tissue plasminogen activator, and plasminogen activator inhibitor were normal. The patient was discharged home on diltiazem after a normal maximal exercise test 16 days after admission.

View larger version (77K): [in this window] [in a new window]   Figure 1. ECG on admission showing anterior ST-segment depression.

View larger version (76K): [in this window] [in a new window]   Figure 2. A 30° right anterior oblique left ventriculograph . . . [Full Text of this Article]

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