Deutsch Marcus-André, Cleuziou Julie, Noebauer Christian, Eicken Andreas, Vogt Manfred, Hoerer Juergen, Lange Ruediger, Schreiber Christian
Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.
Congenit Heart Dis. 2014 Sep-Oct;9(5):E169-74. doi: 10.1111/chd.12117. Epub 2013 Jul 1.
Acute myocardial infarction (MI) is a life-threatening condition rarely encountered in neonates. The patients usually present with sudden cardiogenic shock. Clinical management in neonates is extremely challenging. If treatment is delayed, the prognosis is dismal. We report on a 4-day-old full-term male newborn presenting with acute MI and cardiogenic shock secondary to proximal thromboembolic occlusion of the left descending coronary artery. Hemodynamic stabilization could only be achieved after extracorporeal membrane oxygenation (ECMO) support. Coronary artery patency restoration was performed by selective intracoronary lysis with recombinant tissue plasminogen activator (r-tPA). ECMO support could be discontinued and myocardial function recovered within 6 weeks. We discuss the potential etiologies of acute perinatal MI and the role of ECMO support in the immediate post-MI period. Prompt recognition, timely referral to a cardiac center with availability of specialized advanced treatment options, and management in an orchestrated interdisciplinary approach are crucial for achieving a good outcome.
急性心肌梗死（MI）是一种在新生儿中很少见的危及生命的病症。患者通常表现为突发的心源性休克。新生儿的临床管理极具挑战性。如果治疗延迟，预后很差。我们报告了一名4日龄的足月儿男性新生儿，他因左冠状动脉前降支近端血栓栓塞性闭塞而出现急性心肌梗死和心源性休克。仅在体外膜肺氧合（ECMO）支持后才实现了血流动力学稳定。通过使用重组组织型纤溶酶原激活剂（r-tPA）进行选择性冠状动脉内溶栓来恢复冠状动脉通畅。ECMO支持可以停止，心肌功能在6周内恢复。我们讨论了急性围生期心肌梗死的潜在病因以及ECMO支持在心肌梗死后即刻的作用。迅速识别、及时转诊至具备专业先进治疗方案的心脏中心以及采用精心安排的多学科方法进行管理对于取得良好结果至关重要。
