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Case reports

Contrast-enhanced magnetic resonance imaging guided decision making after primary percutaneous coronary intervention for acute ST-elevation inferior myocardial infarction

^a Cardiothoracic Centre Monaco, Avenue D’Ostende 11, Monte Carlo, Monaco, Italy
^b IRCCS Policlinico, Cardiology, Milan, Italy

Received 18 November 2007; received in revised form 17 March 2008; accepted 22 March 2008.

^_* Corresponding author. Tel.: +39 0377 92168241; fax: +39 0377 92168284. (Email: fabiola_sozzi{at}yahoo.it).

Coronary occlusion of large epicardial branches leads to profound ischemia at the infarct core, resulting in simultaneous necrosis of myocytes and endothelial cells. This process leads to microvascular obstruction in the infarct core, described as the no-reflow region in basic studies and documented in humans by contrast-enhanced magnetic resonance imaging and ultrasound. After coronary occlusion, contrast-enhanced magnetic resonance identifies myocardial infarction as a hyperenhanced region containing a hypoenhanced core. There is growing interest in incorporating its assessment into the evaluation of acute myocardial infarction because it is the key in defining specific therapeutic strategies and in directing the interventional therapy. We report a rare case of right ventricular infarction where contrast-enhanced magnetic resonance produced detailed images of myocardial perfusion pattern and tissue damage and directed the treatment after acute myocardial infarction.

Key Words: Cardiac magnetic resonance • Right ventricular infarction • No-reflow phenomenon

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