12. tbl. 98. árg. 2012

Cardiac arrest in a teenager – a case report

Hjartastopp hjá unglingsstúlku – sjúkratilfelli

Cardiac arrest is rarely seen in children and teenagers. We present a 12-year old girl with cardiac arrest following myocardial infarction, that required prolonged cardiac massage and extracorporeal-membranous-oxygenation (ECMO). At coronary angiography the left main coronary artery (LMCA) was stented for a suspected coronary dissection. The contraction of the heart improved and the ECMO-treatment was discontinued a week later. The patient was discharged home, but six months later a coronary artery bypass surgery was performed for in-stent restenosis. Further work-up with computed tomography (CT) showed that the LMCA originated from the right aortic sinus instead of the the left one. This case demonstrates how life threatening myocardial infarction can be caused by coronary artery anomalies.

Valdimarsson VTh1, Hirlekar G5, Olafsson O5, Oskarsson G2, Helgason H2, Sigurdsson SE5, Tomasdottir H1, Eyjolfsson K3, Gudbjartsson T4,6

1Departments of Anesthesia and Intensive Care, 2Pediatrics, 3Cardiology and 4Cardiothoracic surgery, Landspitali University Hospital, 5Department of Anesthesia and Intensive Care, Akureyri Hospital, 6Faculty of Medicine, University of Iceland.

Figure 1. Chest X-ray at admission in Akureyri Hospital.

Figure 2. Serum Troponin-T mesurement (ug/L) (normal value < 0,01 ug/L).

Figure 3. An EKG 24 hours after beginning of symptoms.

Figure 4. Emergency coronary angiography 24 hours after first symptoms. A 10 mm stenosis in the main stem of the left coronary artery can be seen (arrow).

Figure 5. A CT scan showing anomalous origin of the left main coronary artery (arrow) from the right aortic sinus, also showing the course of the vessel between the aorta and pulmonary trunk.

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