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Case Report

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Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander?

  • LEONARDA GALIUTO1
  • CARLA FAVOCCIA1
  • LUCA TORTOROLO2
  • MARIA L DANZA1
  • ELENA DE VITO1
  • ELISA FEDELE1
  • GABRIELLA LOCOROTONDO1
  • ANTONIO G REBUZZI1
  • FILIPPO CREA1

1,Institute of Cardiology Catholic University of the Sacred Heart

2,Institute of Paediatric Clinics Catholic University of the Sacred Heart

DOI: 10.22514/SV82.102013.11 Vol.8,Issue 2,October 2013 pp.61-63

Published: 17 October 2013

*Corresponding Author(s): LUCA TORTOROLO E-mail: luca.tortorolo@rm.unicatt.it

Abstract

We present the case of a 13 year old patient with myocardial bridge in left anterior descending coronary artery, who develops a myocardial infarction after a cardiothoracic trauma. 

About 24 hours after admission for trauma, an Electrocardiogram (ECG) showed an ST-segment elevation on anterior-lateral leads and QS complex referable to anterior-septal infarction, and an increase in troponin T serum levels was noted. An impaired left ventricular ejection fraction with diffuse regional wall motion abnormalities involving the left ventricular apex and interventricular septum were seen at transthoracic echocardiography. Contrast enhanced cardiac magnetic resonan-ce showed a widespread myocardial edema and necrosis at the level of left ventricular apex and interventricular septum. Intramural hemorrhage and signs of microvascular damage were found mainly at the mid-ventricular level of the antero-septal and anterior segments of myocardium. The coronary angiography revealed normal coronary arteries except for a myocardial bridge on distal part of left anterior descending coronary artery. A myocardial infarction with hemorrhage and microvascular damage was diagnosed, but the absence of a correspondence between site of the most severe myocardial injury and distal location of myocardial bridge was noted. Whether myocardial infarction and microvascular damage have been caused only by traumatic hit, or also by the contribution of myocardial bridge, is unknown. An intense constriction of left anterior descending coronary artery at the level of myocardial bridge could have determined thrombus formation with subsequent septal and distal embolization and myocardial infarction. 

Keywords

myocardial bridge, myo-cardial infarction, contrast-enhan-ced cardiac magnetic resonance, coronary arteries, thrombus, thoracic trauma

Cite and Share

LEONARDA GALIUTO,CARLA FAVOCCIA,LUCA TORTOROLO,MARIA L DANZA,ELENA DE VITO,ELISA FEDELE,GABRIELLA LOCOROTONDO,ANTONIO G REBUZZI,FILIPPO CREA. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander?. Signa Vitae. 2013. 8(2);61-63.

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