The American Heart Hospital Journal
Figure 1: Coronary Angiography Showed Normal Coronary Arteries
Case Report
Figure 2: Transesophageal Echocardiography with Bubble Study Revealed a Tunnel-shaped 8 mm Patent Foramen Ovale and Significant Right-to-left Shunt via Atrial Septum
tunnel-shaped 8 mm patent foramen ovale (PFO) with significant right-to-left shunt seen on her bubble study (see Figure 2). After discussion with the patient about different treatment options including aspirin and anticoagulation, the patient opted for PFO closure which was successfully performed using an amplatzer closure device (see Figure 3). The patient remains stable at six-month follow-up and is off contraceptive medication. Her wall motion abnormalities remained unchanged on follow-up echocardiographic examination.
Discussion
Extensive MI in the setting of normal coronary arteries in young adults can have a variety of non-atherosclerotic causes, including vasculitis, trauma, vasospasm, spontaneous dissection, congenital coronary anomalies, Takotsubo (or stress-induced) cardiomyopathy, or embolization into the coronary arteries (infectious endocarditis, mitral valve prolapse, cardiac myxoma, atrial fibrillation, paradoxical emboli, etc.).1
LA = left atrium; RA = right atrium.
Figure 3: Successful Patent Foramen Ovale Closure Using Amplatzer Device
In this case, paradoxical embolism was the most likely cause of her extensive MI. Stress-induced cardiomyopathy was unlikely due to persistent localized wall motion abnormalities and lack of emotional or physical stress. She had hypercoagulable state due to long-term consumption of oral contraceptives, together with the presence of a PFO.2–4
the overlying septum secundum and septum primum1 is found in 25–30 % of autopsies and in community based
Her PFO was a tunnel-like space between which
Winter 2011 Acute Myocardial Infarction Secondary to Suspected Paradoxical Emboli through Patent Foramen Ovale in a Young Woman 123
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