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PEDIATRICS Vol. 114 No. 2 August 2004, pp. e255-e258

ELECTRONIC ARTICLE

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia

Nicola Carano, MD*, Aldo Agnetti, MD, Donald J. Hagler, MD{ddagger}, Bertrand Tchana, MD*, Umberto Squarcia, MD* and Sergio Bernasconi, MD*

* Department of Pediatrics, University of Parma, Parma, Italy
{ddagger} Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota

We report an 8-year-old girl who presented with clinical features of an acute myocardial infarction. The angiographic appearance of the coronary arteries was normal. A thrombophilic state caused by a homozygote genotype for the prothrombin G20210A mutation was detected, and a patent foramen ovale (PFO) with right-to-left shunting after Valsalva maneuver was demonstrated by transesophageal contrast echocardiography. No other embolic source was identified. We suggest that paradoxical embolization through a PFO resulted in a myocardial infarction in this young patient with hereditary thrombophilia. We closed the patient’s PFO with a 25-mm PFO occluder. She was anticoagulated with warfarin for 6 months. After 6 months, a contrast echocardiogram showed no evidence of residual atrial shunt. There has been no evident recurrent paradoxical embolization.

Key Words: myocardial infarction • patent foramen ovale • hypercoagulable state • prothrombin G20210A • paradoxic embolism

Abbreviations: PFO, patent foramen ovale • MI, myocardial infarction • ECG, electrocardiogram

Received for publication Dec 1, 2003; Accepted Mar 3, 2003.