Myocardial ischemia: atypical presentation of an atrial septal defect in childhood.

We describe a 17-year-old male with a secundum atrial septal defect (ASD), who presented with acute myocardial ischemia. The presumptive diagnosis of a paradoxical coronary embolism was based on the demonstration of a large ASD in conjunction with normal coronary arteries, a negative endomyocardial biopsy, and a negative drug screen. After percutaneous closure with an Amplatzer device, there has been no recurrence for 2 years.