Case Report (n=1)
Highlights a rare presentation of embolic STEMI in an adult with Fontan circulation successfully treated with aspiration thrombectomy and triple antithrombotic therapy.
Supports aspiration thrombectomy for embolic STEMI in Fontan patients; hypothesis-generating and requires prospective validation.
A 24-year-old male with past medical history of hypoplastic left heart syndrome and staged reconstructive surgery in infancy culminating in the Fontan circulation presented to the hospital with a chief complaint of chest pain described as an "elephant sitting" on his chest. Initial 12-lead electrocardiogram revealed 2-mm ST segment elevation in inferior leads, 3-mm ST-segment elevation in anterolateral precordial leads V3 and V4, and 2-mm ST-segment elevation in V5 and V6, with right axis deviation. He was transported emergently to the cardiac catheterization laboratory where coronary angiography revealed complete occlusion of multiple anomalous branches of the right coronary system with hazy appearance suggesting the presence of thrombotic material. An aspiration catheter was used successfully to reestablish TIMI grade III flow. The patient was treated with aspirin, brilinta (ticagrelor), and anticoagulation with vitamin K antagonism to prevent recurrent thromboembolic complications.
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Shamoon et al. (2016) conducted a case report in Embolic ST-Elevation Myocardial Infarction in Repaired Hypoplastic Left Heart Syndrome (n=1). Aspiration thrombectomy and medical therapy (aspirin, ticagrelor, vitamin K antagonist) was evaluated on Reestablishment of TIMI grade III flow.
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