SUCCESSFUL DELIVERY FOLLOWING MYOCARDIAL-ISCHEMIA DURING THE 2ND TRIMESTER OF PREGNANCY

Acute myocardial infarction during pregnancy is considered to be assoc iated with approximately 50% mortality of both mother and fetus. Howev er, there are not enough data regarding the role of acute myocardial i schemia. We present a 36-year-old, pregnant, white female who was admi tted twice at 18 and 20 weeks of gestation with acute myocardial ische mia. Cardiac catheterization revealed 70-80% stenosis of the mid left anterior descending artery (LAD) with normal antegrade flow and very g ood retrograde filling of the LAD from distal collaterals of the right coronary artery. Therefore, due to angiographic suggestion of protect ed LAD territory, we recommended medical therapy and scheduled a vagin al delivery that was successfully completed without cardiovascular com plications. A stress thallium test performed 6 months later was normal , supporting our clinical judgment. In conclusion, every case of a pre gnant woman with coronary insufficiency should be treated according to individual coronary anatomy and blood supply to the territory of the diseased artery, and should not be based on the old data in the litera ture. The decision for revascularization prior to delivery versus medi cal therapy, or Caesarean section versus natural delivery, should be m ade by a team of a cardiologist and an obstetrician.