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Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e424-e427 (doi:10.1542/peds.2006-3181)
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EXPERIENCE & REASON

Myocardial Infarction in an Adolescent: Anomalous Origin of the Left Main Coronary Artery From the Right Coronary Sinus in Association With Combined Prothrombotic Defects

Martin Koestenberger, MDa, Bert Nagel, MDa, Andreas Gamillscheg, MDa, Werner Temmel, MDb, Gerhard Cvirn, PhDc, Albrecht Beitzke, MDa

a Division of Pediatric Cardiology, Department of Pediatrics
b Division of Pediatric Radiology, Department of Radiology
c Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria

ABSTRACT

We present the case of a 15-year-old boy with clinical features of an acute myocardial infarction. Angiography revealed a complete obstruction of the left main coronary artery. A coronary-aorto-bypass graft was undertaken immediately. Cardiac computed tomography demonstrated an anomalous origin of the left main coronary artery from the right coronary sinus of the aorta. A thrombophilic state with a heterozygote genotype for prothrombin G20210 mutation, a C677T methylenetetrahydrofolate reductase gene mutation, and a protein C type 1 deficiency was detected. No other embolic source could be identified. The patient recovered with persistent left ventricular dysfunction. He is now taking the anticoagulant warfarin. Combined prothrombotic defects in combination with additional risk factors such as coronary anomalies can lead to myocardial infarction even in children and adolescents.

Key Words: myocardial infarction • adolescent • coronary anomaly • prothrombotic defects

Abbreviations: MI, myocardial infarction • MTHFR, methylenetetrahydrofolate reductase • LMT, left main trunk • RCA, right coronary artery • CT, computed tomography

Accepted Jan 25, 2007.


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