Intracoronary recombinant tissue plasminogen activator in an infant with hypoplastic left heart syndrome and complete...

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Neonatal Critical Care

Background:

• Hypoplastic left heart syndrome (HLHS) poses complex challenges, often involving single ventricle physiology.
• Coronary artery thrombosis is a rare but critical complication in infants with single ventricle physiology.
• Existing guidelines for managing coronary artery thrombosis in this population are insufficient.

Observation:

• An infant diagnosed with HLHS presented with complete heart block and severe myocardial dysfunction.
• The patient required extracorporeal membrane oxygenation (ECMO) support due to complete left main coronary artery (LMCA) thrombosis.
• The thrombosis severely compromised cardiac function, necessitating urgent intervention.

Findings:

• Successful recanalization of the LMCA and its branches was achieved using intra-coronary infusion of recombinant tissue plasminogen activator (rt-PA).
• The interventional procedure restored coronary blood flow, alleviating the acute ischemic insult.
• The infant demonstrated improved myocardial function post-intervention.

Implications:

• This case demonstrates a potentially effective therapeutic strategy for acute coronary thrombosis in infants with single ventricle physiology.
• The findings suggest rt-PA infusion may be a viable option when standard treatments are inadequate.
• Further research is warranted to establish definitive management protocols for coronary artery thrombosis in pediatric single ventricle patients.