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Thrombolysis with tissue-type plasminogen activator following cardiac surgery in children
A Asante-Korang1, N Sreeram, R McKay
1Heart Clinic, Royal Liverpool Children's Hospital, Alder Hey, UK.
Insights
Intravenous recombinant tissue-type plasminogen activator effectively treated thrombosis in children after cardiac surgery. While generally safe and effective, one patient with Budd-Chiari syndrome experienced organ failure despite treatment.
Area of Science:
- Cardiology
- Pediatric Surgery
- Thrombolytic Therapy
Background:
- Postoperative thrombosis is a serious complication in pediatric cardiac surgery.
- Intracardiac and vascular thrombi can significantly impact patient outcomes.
- Limited data exists on thrombolytic therapy in this specific population.
Observation:
- Three pediatric patients developed major thrombosis post-cardiac operations.
- Diagnoses included left atrial thrombus, right atrial thrombus, and Budd-Chiari syndrome.
- Cross-sectional and Doppler echocardiography were crucial for diagnosis and monitoring.
Findings:
- Systemic recombinant tissue-type plasminogen activator (t-PA) was administered intravenously.
- Two patients with atrial thrombi showed successful treatment outcomes.
- One patient with Budd-Chiari syndrome achieved partial recanalization but experienced multi-organ failure.
Implications:
- Systemic t-PA appears safe and effective for postoperative thrombosis in pediatric cardiac surgery.
- Echocardiography is vital for managing thrombolytic therapy in these cases.
- Further research is needed for complex cases like Budd-Chiari syndrome post-Fontan procedure.
Abstract:
Three children with major intracardiac or vascular thrombosis following cardiac operations were treated with intravenous recombinant tissue-type plasminogen activator. The first patient, aged 10 yr, developed a left atrial thrombus following replacement of the mitral valve with a Björk-Shiley prosthesis. The second patient, aged 16 months, had a right atrial thrombus following a modified Fontan procedure for tricuspid atresia. Both were successfully treated with a short course of intravenous tissue plasminogen activator. The third patient, aged 19 months, developed the Budd-Chiari syndrome with occlusion of the inferior caval vein following a modified Fontan operation for double inlet left ventricle. Even though near-complete thrombolysis and recanalization of the inferior caval vein was achieved with three courses of tissue plasminogen activator on successive days, she died with failure of multiple organs. In all cases, the diagnosis was established by cross-sectional and Doppler echocardiography, and the response to therapy was monitored using the same technique. Thrombolytic therapy with systemic tissue-type plasminogen activator was safe and effective in the postoperative period, with no major haemorrhagic complications.