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Occlusive aortic arch thrombus in a preterm neonate.
Johny Vakayil Francis1, Paul Monagle, Sarah Hope
1Monash Newborn, Monash Medical Centre, VIC, Australia.
Summary
This case study details an extremely preterm infant who developed a rare aortic arch clot. Low-risk therapy led to complete resolution, offering a novel approach for neonatal aortic arch thrombosis.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular surgery
- Vascular medicine
Background:
- Neonatal aortic arch thrombosis is exceptionally rare, with previous reports exclusively in term infants.
- Occlusive thrombus in the aortic arch presents a significant challenge in extremely preterm neonates.
Observation:
- An extremely preterm infant (28 weeks gestation) presented with clinical signs suggestive of aortic arch obstruction.
- Echocardiography confirmed an occlusive thrombus in the aortic arch distal to the innominate artery, extending into the carotid artery.
Findings:
- The infant was managed with intravenous prostaglandin E and anticoagulation (heparin, later enoxaparin).
- Serial echocardiograms over three months demonstrated complete resolution of the aortic arch thrombus.
- This represents the first reported case of successful low-risk therapy for aortic arch thrombosis in a preterm infant.
Implications:
- This case highlights the potential efficacy of conservative, low-risk therapeutic strategies in managing neonatal aortic arch thrombosis in preterm infants.
- Individualized risk-benefit assessment is crucial when considering anticoagulation or thrombolytic therapy for this rare condition.
- Further research is warranted to establish optimal management protocols for neonatal aortic arch thrombus across different gestational ages.
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