Abstract
We report the case of a young female with embolic myocardial infarction. The embolic etiology was confirmed by Fourier Domain Optical Coherence Tomography as well as histo-pathology.
A 20-year-old female patient with previous history of atrioventricular canal defect, operated on in her childhood, was referred to our center for out-of-hospital resuscitated sudden cardiac arrest. Upon admission, the patient was hemodynamically stable and neurologically nonreactive. EKG revealed an atrial fibrillation, at 100 beats per minute with inverted T waves in precordial leads. Blood test results were unremarkable except for cardiac enzyme elevation. Transthoracic echocardiography showed a mitral cleft with severe mitral regurgitation and no residual intracardiac shunt; transesophageal echography was not performed. The coronary angiogram showed a suboccluded proximal left anterior descending artery (LAD) with a TIMI I flow ( Fig. 1 A ). Thrombo-aspiration was performed restoring a TIMI III flow; the aspirated material was gray white and gelatinous, consistent with white thrombus. Fourier domain optical coherence tomography (OCT) revealed a hypersignal image protruding in the lumen with a normal coronary three-layer pattern: the medium is seen as a dark band delimited by the internal elastic lamina and external elastic lamina ( Fig. 1 B). Despite the normal underlying coronary anatomy, a percutaneous angioplasty was performed with stent implantation into the proximal LAD for two reasons: lack of evidence about the optimal treatment for this entity, and persistence of a critical luminal narrowing with a minimal lumen area of 2 mm 2 measured by OCT. The patient received optimal antithrombotic therapy. The histopathological analysis of the aspirated material showed a platelet-rich white thrombus ( Fig. 1 C). The patient died days later from multiple organ failure.
