Abstract: We present a case study of intrauterine myocardial infarction. A female neonate suffered from cardiopulmonary arrest at birth. She presented with refractory cardiogenic shock and died. Echocardiogram showed absence of movement of the posterolateral wall of the left chamber. Autopsy showed severe and extensive myocardial necrosis confined by a band of dystrophic calcification that suggested intrauterine origin. The circumflex artery and anterior descending coronary artery both presented with very narrow calibers. Sympathicomimetics administered to the mother also could have played a role in the development of infarction. Myocardial infarction should be suspected if signs of ischemia are present and there is no clear hypoxic-ischemic insult around delivery. Prognosis is poor especially if the main stem of the left coronary is involved. Cardiac transplantation can be considered.
Abstract: Coronary artery anomalies constitute 2.2 % of congenital malformations of the heart. The most common abnormality is anomalous origin of the left coronary artery from the pulmonary trunk, also known as Bland-White-Garland syndrome. Clinical manifestations are due to myocardial ischemia caused by the creation of an arteriovenous shunt. The childhood type of this anomaly presents high mortality from heart failure. The adult type develops myocardial infarction, arrhythmias, sudden cardiac death or signs of congestive heart failure. Surgical repair is essential. Various surgical approaches are available and the treatment of choice is direct left coronary artery reimplantation in the aorta. An alternative technique is to create an aortopulmonary tunnel (Takeuchi technique). Marked improvement is usually observed after surgical repair. We report two cases of myocardial ischemia due to coronary anomalies.
Abstract: Accurate patient triage for the early identification of potentially seriously ill or high-risk children is needed due to the increasing demands made on paediatric emergency departments.
