Thrombotic Occlusion of Ectatic Coronary Arteries in a Young Patient

J INVASIVE CARDIOL 2018;30(10):E101-E102.

Key words: angiography, cardiac imaging, pediatric cardiology

A 15-year-old male with past medical history of Kawasaki disease presented to our emergency room with complaints of severe retrosternal, crushing chest pain at rest associated with nausea and diaphoresis. Physical examination revealed dry mucous membranes. Electrocardiogram showed acute ST-elevation myocardial infarction and laboratory testing showed elevated cardiac enzymes. He was taken to cardiac catheterization laboratory emergently with placement of Impella 2.5 (in view of decreasing left ventricular function) followed by coronary angiography, which showed significantly ectatic left main coronary artery, left anterior descending (LAD) coronary artery, left circumflex (LCX) coronary artery, and right coronary artery (RCA), with associated thrombotic occlusion of the LAD, LCX, and RCA (Figure 1). Intracoronary thrombolysis of the infarct-related artery (RCA) was performed using tissue plasminogen activator 250,000 U/kg 3 times daily for 2 days (Figure 2). Multiple rounds of aspiration thrombectomy followed by balloon angioplasty of the LAD failed to completely restore the flow into the distal LAD secondary to re-occlusion from thrombus formation (Figures 3-5). The patient recovered well with improvement in myocardial pump function, with an ejection fraction of approximately 45%-50% on discharge.

From the Division of Cardiovascular Disease, Kansas University Medical Center, Kansas City, Kansas.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted April 13, 2018. 

Address for correspondence: Tawseef Dar, MD, Cardiac Arrhythmia Research, Division of Cardiovascular Disease, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160. Email: dartauseef22@gmail.com