In Situ Alteplase for Rescue Recanalization After Glenn Thrombosis

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Superior vena cava (SVC) thrombosis is a critical complication following Glenn palliation, leading to acute cavopulmonary circuit failure.
• Hypoplastic left heart syndrome (HLHS) patients undergoing Glenn palliation are at risk for SVC thrombosis and subsequent complications.

Purpose of the Study:

• To report a successful case of catheter-directed thrombolysis for SVC thrombosis in an infant with HLHS.
• To evaluate the efficacy and safety of alteplase infusion via an indwelling catheter for SVC-Glenn thrombosis.

Main Methods:

• A 6-month-old boy with HLHS developed SVC syndrome due to catheter-associated SVC-Glenn thrombosis and pulmonary embolisms post-Glenn procedure.
• Alteplase was infused in situ through the existing catheter at 0.2 mg/kg/h for 72 hours.
• The patient had experienced mediastinal hemorrhage and required veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Main Results:

• Complete recanalization of the SVC-Glenn thrombus was achieved.
• The thrombolysis was performed without any bleeding complications.
• Successful treatment allowed for avoidance of further invasive procedures like surgery or mechanical disruption.

Conclusions:

• Catheter-directed alteplase is an effective treatment for SVC thrombosis after Glenn palliation, even in complex cases involving hemorrhage and ECMO support.
• When an indwelling catheter traverses the thrombus, it provides a direct route for effective thrombolysis.
• This minimally invasive approach offers a safe alternative to surgery or mechanical thrombectomy in high-risk pediatric patients.