Multimodal Image in a Coronary Embolism-Induced Acute Myocardial Infarction in a Mechanical Aortic Valve Recipient.

BACKGROUND

Coronary embolism is an uncommon etiology of acute myocardial infarction, particularly in patients with mechanical heart valves.

CASE: A 47-year-old woman with mechanical aortic valve replacement presented with non-ST-segment elevation myocardial infarction after temporary warfarin interruption. Computed tomography angiography and coronary angiography revealed a mobile thrombus in the mid-left anterior descending artery, which was confirmed as embolic origin by intravascular ultrasound.

MANAGEMENT: Initial thrombus aspiration yielded suboptimal results. Subsequent balloon angioplasty was performed, achieving TIMI flow grade 3 restoration. Anticoagulation therapy with warfarin was reinitiated for long-term management.

CONCLUSIONS

This case highlights the critical role of intravascular imaging in diagnosing embolic acute myocardial infarction and the efficacy of mechanical thrombus modification when thrombus aspiration alone is inadequate.