Neonatal myocardial infarction due to coronary thrombus is a rare cause of acute heart failure and is associated with high morbidity and mortality. We present a rare case of a full-term newborn who developed coronary artery thrombus treated with intracoronary recombinant tissue plasminogen activator infusion while undergoing therapeutic hypothermia. Also, we describe a unique treatment strategy to support systemic circulation sparing the patient from neonatal extracorporeal membrane oxygenation and its complications. Neonatal myocardial infarction should be suspected and ruled out in sick newborns.
PapnejaK, ChanAK, MondalTK, PaesB. Myocardial infarction in neonates: A review of an entity with significant morbidity and mortality. Pediatr Cardiol.. 2017. 38(3):427–41.
2.
BamberAR, PryceJ, CookA, AshworthM, SebireNJ. Myocardial necrosis and infarction in newborns and infants. Forensic Sci Med Pathol. 2013. 9(4):521–7.
3.
CesnaS, EickenA, JuengerH, HessJ. Successful treatment of a newborn with acute myocardial infarction on the first day of life. Pediatr Cardiol. 2013. 34(8):1868–70.
4.
MolkaraD, SepulvedaJAS, DoT, DavisC, GoldsteinGP, MooreJW, et al.Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function. Congenit Heart Dis. 2017. 12(3):270–4.
5.
JacobsSE, BergM, HuntR, Tarnow-MordiWO, InderTE, DavisPG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;2013(1)CD003311.
6.
MuruganSJ, GnanapragasamJ, VettukattilJ. Acute myocardial infarction in the neonatal period. Cardiol Young. 2002. 12(4):411–3.
7.
Rodríguez MartínezM, Ruiz GonzálezE, Parra-LlorcaA, TorresMV, Aguar CarrascosaM. Myocardial infarction in neonates: A diagnostic and therapeutic challenge. Case Rep Pediatr. 2019;2019:7203407.
FarooqiKM, SuttonN, WeinsteinS, MenegusM, Spindola-FrancoH, PassRH. Neonatal myocardial infarction: Case report and review of the literature. Congenit Heart Dis. 2012. 7(6):E97–102.
10.
DeutschM-A, CleuziouJ, NoebauerC, EickenA, VogtM, HoererJ, et al.Successful management of neonatal myocardial infarction with ECMO and intracoronary r-tPA lysis. Congenit Heart Dis. 2014. 9(5):E169–174.
11.
HallbergsonA, GillespieMJ, DoriY. A case of neonatal myocardial infarction: Left coronary artery thrombus resolution and normalisation of ventricular function by intracoronary low-dose tissue plasminogen activator. Cardiol Young. 2015. 25(4):810–2.
12.
Mohammad NijresB, NelsonPM, VettukattilJJ. Catheter-induced acute Blalock-Taussig shunt thrombosis and bailout. Cardiol Young. 2020. 30(10):1512–4.
13.
Mohammad NijresB, HuntingtonJH, BaliulisG, VettukattilJJ. Intracoronary recombinant tissue plasminogen activator in an infant with hypoplastic left heart syndrome and complete left main coronary artery thrombosis. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2019. 93(7):E381–4.
14.
KimF, BernbaumJ, ConnellyJ, GerdesM, HedrickHL, HoffmanC, et al.Survival and developmental outcomes of neonates treated with extracorporeal membrane oxygenation: A 10-year single-center experience. J Pediatr. 2021. 229:134–140.e3.
15.
MonagleP, ChanAKC, GoldenbergNA, IchordRN, JourneycakeJM, Nowak-GöttlU, et al.Antithrombotic therapy in neonates and children. Chest. 2012. 141(2):e737S–e801S.
16.
BratinscákA, MooreJW, El-SaidHG. Low dose tissue plasminogen activator treatment for vascular thrombosis following cardiac catheterization in children: A single center experience. Catheter Cardiovac Interv. 2013. 82(5):134–9.
17.
KapurNK, AlkhouliMA, DeMartiniTJ, FarazH, GeorgeZH, GoodwinMJ, et al.Unloading the left ventricle before reperfusion in patients with anterior st-segment-elevation myocardial infarction. Circulation. 2019. 139(3):782–5.
18.
KapurNK, AnnamalaiS, ReyeltL, KarmiySJ, RazaviAA, ForoutanjaziS, et al. From bedside to bench and back again: Translational studies of mechanical unloading of the left ventricle to promote recovery after acute myocardial infarction. F1000 Res. 2018;7:F1000 Faculty Rev-1852.
19.
MeuweseCL, deHaan M, ZwetslootP-P, BraithwaiteS, RamjankhanF, vander Heijden J,et al.. The hemodynamic effect of different left ventricular unloading techniques during veno-arterial extracorporeal life support: A systematic review and meta-analysis. Perfusion. 2020. 35(7):664–71.
20.
FukushimaY, BabaK, KondoM, KuritaY, EitokuT, ShigemitsuY,et al.. Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum. Pediatr Int Off J Jpn Pediatr Soc. 2019. 61(4):339–44.
