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Clinical Pediatrics
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Endocardial Fibroelastosis With Coronary Artery Thromboembolus and Myocardial Infarction

Kathryn L. Lane, MD

From the Department of Pathology, Duke University Medical Center, Durham, North Carolina

Arlene J. Herzberg, MD

From the Department of Pathology, Duke University Medical Center, Durham, North Carolina

Keith A. Reimer, MD, PhD

From the Department of Pathology, Duke University Medical Center, Durham, North Carolina

William D. Bradford, M.D.

From the Department of Pathology, Duke University Medical Center, Durham, North Carolina

Stewart A. Schall, MD

Division of Pediatric Cardiology, The University of North Carolina - Chapel Hill, The Moses H. Cone Memorial Hospital, Greensboro, North Carolina

We report a case of an 18-month-old male, born to a woman with third trimester febrile illness, who had a history of congestive heart failure and respiratory distress, cardiomegaly, and electrocardiographic (ECG) findings suggestive of cardiomyopathy and myocarditis. After gradual improvement in heart size and function with pharmacologic therapy, he developed a terminal episode of respiratory distress and cardiogenic shock, with ECG findings of an anterolateral infarct. At autopsy it was found that endocardial fibroelastosis with mural thrombi in the left ventricle had been complicated by thromboembolism to the left anterior descending coronary artery, resulting in transmural infarction of the anteroseptal region of the left ventricle. Myocardial infarction is a potential but unusual thromboembolic complication of endocardial fibroelastosis. A high index of suspicion for coronary artery thromboemboli should be maintained in pediatric patients with cardiomyopathy and suspected myocardial infarction.

Clinical Pediatrics, Vol. 30, No. 10, 593-598 (1991)
DOI: 10.1177/000992289103001004
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