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Chapter 6 - Ischaemia and Infarction

Published online by Cambridge University Press:  19 August 2019

Michael T. Ashworth
Great Ormond Street Hospital for Children, London
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This chapter is devoted to the macroscopic and microscopic appearance of myocardial ischaemia and includes discussion of regional myocardial infarction and of papillary muscle rupture. Coronary atherosclerosis can occur, albeit rarely, in the child, and this is discussed particularly in relation to hypercholesterolaemia. Antiphospholipid syndrome and haemolytic-uraemic syndrome are also discussed.

Pathology of Heart Disease in the Fetus, Infant and Child
Autopsy, Surgical and Molecular Pathology
, pp. 155 - 163
Publisher: Cambridge University Press
Print publication year: 2019

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Ascuitto, RJ, Ross-Ascuitto, NT. Substrate metabolism in the developing heart. Semin Perinatol 1996; 20: 542563.CrossRefGoogle ScholarPubMed
Patterson, AJ, Zhang, L. Hypoxia and fetal heart development. Curr Mol Med 2010; 10: 653666.CrossRefGoogle ScholarPubMed
Franciosi, RA, Blanc, WA. Myocardial infarcts in infants and children. I. A necropsy study in congenital heart disease. J Pediatr 1968; 73: 309319.CrossRefGoogle ScholarPubMed
Bor, I. Myocardial infarction and ischaemic heart disease in infants and children. Analysis of 29 cases and review of the literature. Arch Dis Child 1969; 44: 268281.CrossRefGoogle ScholarPubMed
De Lucia, V, Andreassi, MG, Sabatini, L et al. Myocardial infarction and arterial thrombosis in identical newborn twins with homozygosity for the PAI-1 4 G/5 G polymorphism. Int J Cardiol 2009; 137: e1–4.CrossRefGoogle Scholar
Clark, AB, Stokes, TA, Krous, HF, Carbine, DN. Myocardial infarction in a newborn heterozygous for the MTHFR C677T mutation. Pediatr Dev Pathol 2012; 15: 232236.CrossRefGoogle Scholar
Donnelly, WH, Bucciarelli, RL, Nelson, RM. Ischemic papillary muscle necrosis in stressed newborn infants. J Pediatr 1980; 96: 295300.CrossRefGoogle ScholarPubMed
Barberi, I, Calabrò, MP, Cordaro, S et al. Myocardial ischemia in neonates with perinatal asphyxia. Electrocardiographic, echocardiographic and enzymatic correlations. Eur J Pediatr 1999; 158: 742747.CrossRefGoogle ScholarPubMed
Murugan, SJ, Gnanapragasam, J, Vettukattil, J. Acute myocardial infarction in the neonatal period. Cardiol Young 2002; 12: 411413.CrossRefGoogle ScholarPubMed
de Vetten, L, Bergman, KA, Elzenga, NJ et al. Neonatal myocardial infarction or myocarditis? Pediatr Cardiol 2011; 32: 492497.CrossRefGoogle ScholarPubMed
Richart, R, Benirschke, K. Myocardial infarction in the perinatal period: report of two cases in newborn infants. J Pediatr 1959; 55: 706712.CrossRefGoogle Scholar
Brown, NJ. Proceedings: myocardial infarction in the newborn. Arch Dis Child 1974; 49: 19741976.CrossRefGoogle ScholarPubMed
Iannone, LA, Duritz, G, McCarty, RJ. Myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries. Am Heart J 1975; 89: 232235.CrossRefGoogle ScholarPubMed
Kilbride, H, Way, GL, Merenstein, GB, Winfield, JM. Myocardial infarction in the neonate with normal heart and coronary arteries. Am J Dis Child 1980; 134: 759762.Google ScholarPubMed
Cabrera, A, Izquierdo, MA, Bilbao, FJ. Myocardial infarction with ventricular aneurysm in a newborn with normal coronary arteries. Int J Cardiol 1991; 31: 243245.CrossRefGoogle Scholar
Setzer, E, Ermocilla, R, Tonkin, I et al. Papillary muscle necrosis in a neonatal autopsy population: incidence and associated clinical manifestations. J Pediatr 1980; 96: 289294.Google Scholar
Bamber, AR, Pryce, J, Cook, A, Ashworth, M, Sebire, NJ. Myocardial necrosis and infarction in newborns and infants. Forensic Sci Med Pathol 2013; 9: 521527.CrossRefGoogle ScholarPubMed
Riede, FT, Dähnert, I, Razek, V, Kostelka, M. Rupture of the papillary muscle of the tricuspid valve – echocardiographic diagnosis of a rare anomaly leading to critical tricuspid valve regurgitation in the newborn. Eur J Pediatr 2010; 169: 165166.CrossRefGoogle ScholarPubMed
Bakiler, AR, Aydoğdu, SA, Erişen, S, Yenigün, A, Atay, Y. A case of mitral papillary muscle rupture due to blunt chest trauma. Turk J Pediatr 2011; 53: 9799.Google ScholarPubMed
Hamaoka, A, Shiraishi, I, Yamagishi, M, Hamaoka, K. A neonate with the rupture of mitral chordae tendinae associated with maternal-derived anti-SSA antibody. Eur J Pediatr 2009; 168: 741743.CrossRefGoogle ScholarPubMed
Birk, E, Stamler, A, Katz, J et al. Anomalous origin of the left coronary artery from the pulmonary artery: diagnosis and postoperative follow up. Isr Med Assoc J 2000; 2: 111114.Google ScholarPubMed
Newburger, JW, Fulton, DR. Kawasaki disease. Curr Opin Pediatr 2004; 16: 508514.CrossRefGoogle ScholarPubMed
Swaney, PM, Nayman, BD, Cabañas, JG, Myers, JB. Fatal myocardial ischemia in a 12-year old secondary to fibromuscular dysplasia. Am J Emerg Med 2014; 32: 812.e5–7.CrossRefGoogle Scholar
Tome-Esteban, MT, Ashworth, M. Hypertrophic cardiomyopathy and acute myocardial necrosis with normal coronary arteries. Heart 2008; 94: 1357.CrossRefGoogle ScholarPubMed
Usifo, E, Leigh, SE, Whittall, RA et al. Low-density lipoprotein receptor gene familial hypercholesterolemia variant database: update and pathological assessment. Ann Hum Genet 2012; 76: 387401.CrossRefGoogle ScholarPubMed
Sjouke, B, Kusters, DM, Kindt, I et al. Homozygous autosomal dominant hypercholesterolaemia in the Netherlands: prevalence, genotype-phenotype relationship, and clinical outcome. Eur Heart J 2015; 36: 560565.CrossRefGoogle ScholarPubMed
Awan, Z, Alrasadi, K, Francis, GA et al. Vascular calcifications in homozygote familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 2008; 28: 777785.CrossRefGoogle ScholarPubMed
Kolansky, DM, Cuchel, M, Clark, BJ et al. Longitudinal evaluation and assessment of cardiovascular disease in patients with homozygous familial hypercholesterolemia. Am J Cardiol 2008; 102: 14381443.CrossRefGoogle ScholarPubMed
Mallory, GK, White, PD, Salcedo-Salgar, J. The speed of healing of myocardial infarction: a study of the pathologic anatomy in seventy-two cases. Am Heart J 1939; 18: 647671.CrossRefGoogle Scholar
Michaud, K. Ischemic heart disease. In Suvarna, SK (ed.) Cardiac Pathology. A Guide to Current Practice. London: Springer; 2013, pp. 117131.Google Scholar
Basso, C, Rizzo, S, Thiene, G. The metamorphosis of myocardial infarction following coronary recanalization. Cardiovasc Patholol 2010; 19: 2228.CrossRefGoogle ScholarPubMed
Sun, Y. Myocardial repair/remodelling following infarction: roles of local factors. Cardiovasc Res 2009; 81: 482490.CrossRefGoogle ScholarPubMed
Lynn, RM, O’Brien, SJ, Taylor, CM, et al. Childhood haemolytic uraemic syndrome, United Kingdom and Ireland. Emerg Infect Dis 2005; 11: 590596.CrossRefGoogle ScholarPubMed
Rigamonti, D, Simonetti, GD. Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature. Eur J Pediatr 2016; 175: 19271931.CrossRefGoogle ScholarPubMed
Machol, K, Vivante, A, Rubinsthein, M et al. Keeping the heart in mind when managing hemolytic: uremic syndrome. Isr Med Assoc J 2011; 13: 446447.Google Scholar
Miyakis, S, Lockshin, MD, Atsumi, T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295306.CrossRefGoogle Scholar
Asherson, RA, Cervera, R, de Groot, PG et al.; Catastrophic Antiphospholipid Syndrome Registry Project Group. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus 2003; 12: 530534.CrossRefGoogle ScholarPubMed
Cervera, R, Espinosa, G. Update on the catastrophic antiphospholipid syndrome and the “CAPS Registry”. Semin Thromb Hemost 2012; 38: 333338.Google ScholarPubMed
McNeil, HP, Simpson, RJ, Chesterman, CN, Krilis, SA. Anti-phospholipid antibodies are directed against a complex antigen that includes a lipid-binding inhibitor of coagulation: beta 2-glycoprotein I (apolipoprotein H). Proc Natl Acad Sci U S A 1990; 87: 41204124.CrossRefGoogle Scholar
Hojnik, M, George, J, Ziporen, L, Shoenfeld, Y. Heart valve involvement (Libman–Sacks endocarditis) in the antiphospholipid syndrome. Circulation 1996; 93: 15791587.CrossRefGoogle ScholarPubMed
Gleason, CB, Stoddard, MF, Wagner, SG et al. A comparison of cardiac valvular involvement in the primary antiphospholipid syndrome versus anticardiolipin-negative systemic lupus erythematosus. Am Heart J 1993; 125: 11231129.CrossRefGoogle ScholarPubMed
Rodríguez-Pintó, I, Moitinho, M, Santacreu, I et al.; CAPS Registry Project Group (European Forum on Antiphospholipid Antibodies). Catastrophic antiphospholipid syndrome (CAPS): Descriptive analysis of 500 patients from the International CAPS Registry. Autoimmun Rev 2016; 15: 120–1124.CrossRefGoogle ScholarPubMed
Berman, H, Rodríguez-Pintó, I, Cervera, R et al.; Catastrophic Registry Project Group (European Forum on Antiphospholipid Antibodies). Pediatric catastrophic antiphospholipid syndrome: descriptive analysis of 45 patients from the “CAPS Registry”. Autoimmun Rev 2014; 13: 157162.CrossRefGoogle ScholarPubMed
Tennstedt, C, Chaoui, R, Vogel, M, Göldner, B, Dietel, M. Pathologic correlation of sonographic echogenic foci in the fetal heart. Prenat Diagn 2000; 20: 287292.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Tran, SH, Caughey, AB, Norton, ME. Ethnic variation in the prevalence of echogenic intracardiac foci and the association with Down syndrome. Ultrasound Obstet Gynecol 2005; 26: 158161.CrossRefGoogle ScholarPubMed
Manning, JE, Ragavendra, N, Sayre, J et al. Significance of fetal intracardiac echogenic foci in relation to trisomy 21: a prospective sonographic study of high-risk pregnant women. Am J Roentgenol 1998; 170: 10831084.CrossRefGoogle ScholarPubMed
Yozgat, Y, Kilic, A, Ozdemir, R et al. Modified myocardial performance index is not affected in fetuses with an isolated echogenic focus in the left ventricle. J Matern Fetal Neonatal Med 2015; 28: 333337.CrossRefGoogle Scholar
Lamont, RF, Havutcu, E, Salgia, S, Adinkra, P, Nicholl, R. The association between isolated fetal echogenic cardiac foci on second-trimester ultrasound scan and trisomy 21 in low-risk unselected women. Ultrasound Obstet Gynecol 2004; 23: 346351.CrossRefGoogle ScholarPubMed
Drut, R, Drut, RM, Alba Greco, M. Massive myocardial calcification in the perinatal period. Pediatr Devel Pathol 1998; 1: 366374.CrossRefGoogle ScholarPubMed
Franklin, RC, Jacobs, JP, Krogmann, ON et al. Nomenclature for congenital and paediatric cardiac disease: historical perspectives and The International Pediatric and Congenital Cardiac Code. Cardiol Young 2008;18 (Suppl 2):70–80.

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