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Thrombus in right atrium in two infants successfully treated with tissue plasminogen activator
E Martínez-Tallo1, F Campo, M Delgado
1Division of Pediatric Intensive Care and Pediatric Cardiology, Infanta Cristina University Hospital, Badajoz, Spain.
Insights
Recombinant tissue-plasminogen activator (rt-PA) effectively dissolved right atrial thrombi in infants treated via central venous catheters. This thrombolytic therapy offers a promising option for pediatric thrombotic complications.
Area of Science:
- Pediatric Cardiology
- Hematology
- Interventional Radiology
Background:
- Central venous catheters are essential in pediatric care but increase risks of thrombotic complications.
- Thrombolytic therapy is indicated for significant venous thromboses in children.
Observation:
- Two infants (4 and 2 months) presented with mobile right atrial thrombi.
- These thrombi were treated using recombinant tissue-plasminogen activator (rt-PA) delivered through a central venous catheter.
Findings:
- Complete clot dissolution was achieved in both infants.
- Resolution times were 8 hours and 44 hours, respectively.
- One infant experienced transient respiratory distress likely due to pulmonary microembolism.
Implications:
- Catheter-directed rt-PA infusion is a viable treatment for pediatric right atrial thrombi.
- This approach may reduce the need for more invasive procedures.
- Monitoring for potential complications like pulmonary embolism and bleeding is crucial.
Abstract:
The widespread use of central venous catheters in children has increased thrombotic complications that warrant thrombolytic therapy. We report the cases of two infants, aged four and two months, with a mobile thrombus in the right atrium treated with recombinant tissue-plasminogen-activator (rt-PA) infused by a central venous catheter. Clot dissolution was obtained in both patients in eight and 44 hours, respectively. One patient presented mild respiratory distress probably from a pulmonary microembolism that disappeared in a few days. Both had minor bleeding from venipuncture sites, but no major hemorrhage.