Successful delivery following myocardial ischemia during the second trimester of pregnancy

Yoseph Shalev*, Menashe Epstein, Oded Ayzenberg, Abraham Caspi, Herzl Ben‐Hur, Zion Hagay, Isaac Blickstein, Alan Gelven

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Acute myocardial infarction during pregnancy is considered to be associated with approximately 50% mortality of both mother and fetus. However, there are not enough data regarding the role of acute myocardial ischemia. We present a 36‐year‐old, pregnant, white female who was admitted twice at 18 and 20 weeks of gestation with acute myocardial ischemia. Cardiac catheterization revealed 70–80% stenosis of the mid left anterior descending artery (LAD) with normal antegrade flow and very good retrograde filling of the LAD from distal collaterals of the right coronary artery. Therefore, due to angiographic suggestion of protected LAD territory, we recommended medical therapy and scheduled a vaginal delivery that was successfully completed without cardiovascular complications. A stress thallium test performed 6 months later was normal, supporting our clinical judgment. In conclusion, every case of a pregnant 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 literature. The decision for revascularization prior to delivery versus medical therapy, or Caesarean section versus natural delivery, should be made by a team of a cardiologist and an obstetrician.

Original languageEnglish
Pages (from-to)754-756
Number of pages3
JournalClinical Cardiology
Issue number10
StatePublished - Oct 1993
Externally publishedYes


  • acute ischemic syndrome
  • coronary artery disease
  • pregnancy


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