Akuter Myokardinfarkt bei spontaner Dissektion der rechten Koronararterie in der 38. Schwangerschaftswoche

Zusammenfassung

Das Auftreten eines Myokardinfarktes in der Schwangerschaft ist ein äußerst seltenes, jedoch mit einer hohen mütterlichen Mortalität belastetes Ereignis. Wir berichten über eine 39jährige Patientin in der 38. SSW mit einer spontanen Dissektion der rechten Kranzarterie als Ursache für einen Hinterwandinfarkt. Die Behandlung erfolgte mittels Einbringen mehrerer Stents in die rechte Kranzarterie. Daraufhin Einstellung der PTT auf 90 bis 120 s mittels Liquemin. Entbindung per Sectio caesarea am darauffolgenden Tag wegen pathologischem CTG bei Plazentainsuffizienz mit Geburt eines lebensfrischen, gesunden Jungen. Bei der Mutter im weiteren Verlauf Entwicklung einer mittelgradigen Mitralinsuffizienz und eines beginnenden Hinterwandaneurysmas als Folgen des Infarktes. Entlassung der Patientin in gutem Zustand etwa drei Wochen nach dem akuten Ereignis.

Abstract

Myocardial infarction during pregnancy is rare and associated with a high maternal mortality rate. We describe a 39-year-old patient in the 38 th week of gestation with spontaneous dissection of the right coronary artery and ensuing posterior wall myocardial infarction. Treatment consisted of immediate cardiac catheterization and stenting of the right coronary artery. The partial thromboplastin time was adjusted to 90 to 120 s with heparin. The next day cesarean section was performed because of a nonreassuring fetal heart rate tracing and a healthy male infant was delivered. The mother subsequently developed moderate mitral-valve insufficiency and a small posterior wall aneurysm and was discharged from the hospital in good condition 3 weeks after the acute event.

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