Coli Stefano, Magnoni Marco, Melisurgo Giulio, Persico Paola, Doldi Nicola, De Cobelli Francesco, Del Maschio Alessandro, Cianflone Domenico, Maseri Attilio
Int J Cardiol. 2007 Jan 31;115(1):e56-7. doi: 10.1016/j.ijcard.2006.07.166. Epub 2006 Oct 24.
Two previous reports have reported myocardial infarction during ovarian hyperstimulation syndrome, a complication of controlled ovarian stimulation characterized by ascites, pleural effusion, hemoconcentration and an increased thromboembolic risk, but no association with the initial phase (before treatment with human chorionic gonadotropin) of a normal ovarian stimulation protocol for infertility has ever been described. We report the first case, to our knowledge, of acute myocardial infarction occurring during the initial phase of an otherwise uncomplicated ovarian stimulation protocol. A young woman with infertility associated to polycystic ovary syndrome was treated with leuprolide acetate and recombinant follicle stimulating hormone to induce ovarian stimulation for in vitro fertilization and embryo transfer. After 12 days the patient presented a non-ST elevation myocardial infarction, which was treated with aspirin, clopidogrel, enoxaparin, intravenous nitrates and beta blockers. Cardiac catheterization showed angiographically normal coronary arteries. Echocardiography showed a circumscribed akinesis of the inferior apical segment of the left ventricle and right ventricular apex, which was confirmed by cardiac magnetic resonance. A screening for thrombophilic diathesis was negative. The patient was discharged and remained asymptomatic at 1 and 3 months follow up. Further ovarian stimulations were excluded and a trial of oocyte retrieval on spontaneous cycle was planned. Myocardial infarction can complicate ovarian stimulation protocols for infertility even in their early phase without any sign of ovarian hyperstimulation syndrome.
此前有两份报告称，在卵巢过度刺激综合征期间发生了心肌梗死，卵巢过度刺激综合征是控制性卵巢刺激的一种并发症，其特征为腹水、胸腔积液、血液浓缩和血栓栓塞风险增加，但从未有过关于正常不孕症卵巢刺激方案初始阶段（用人绒毛膜促性腺激素治疗前）与之关联的描述。据我们所知，我们报告了首例在无并发症的卵巢刺激方案初始阶段发生急性心肌梗死的病例。一名患有多囊卵巢综合征相关不孕症的年轻女性接受了醋酸亮丙瑞林和重组促卵泡激素治疗，以诱导卵巢刺激用于体外受精和胚胎移植。12天后，患者出现非ST段抬高型心肌梗死，接受了阿司匹林、氯吡格雷、依诺肝素、静脉硝酸酯类药物和β受体阻滞剂治疗。心脏导管检查显示冠状动脉造影正常。超声心动图显示左心室下尖段和右心室尖部有局限性运动减弱，心脏磁共振成像证实了这一点。血栓形成倾向筛查结果为阴性。患者出院，在1个月和3个月的随访中无症状。排除了进一步的卵巢刺激，并计划在自然周期进行取卵试验。即使在早期阶段，没有任何卵巢过度刺激综合征的迹象，心肌梗死也可能使不孕症的卵巢刺激方案复杂化。
