Intracardiac thrombus formation with rapidly progressive heart failure in the neonate: treatment with tissue type plasminogen activator.

Abstract

A newborn is described in whom the use of a central venous line was complicated by septicaemia and by intracardiac thrombus formation with tricuspid valve insufficiency and heart failure. Besides antibiotics, treatment consisted of tissue type plasminogen activator (tPA) for three days. This treatment resulted in the disappearance of the thrombus and the tricuspid insufficiency. No adverse effects were noted. Treatment with tPA should be considered in intracardiac thrombus formation with rapidly progressive heart failure in the neonate.As central catheters are used extensively in neonates for parenteral nutrition or administration of medication, formation ofboth infected and non-infected thrombi on the endocardium is increasingly observed. Especially in neonates with very low birth weight such thrombus formation may lead to life threatening situations. Treatment of these cases is difficult. [1][2][3] We report on our experience with tissue type plasminogen activator (tPA), a new thrombolytic agent, in a newborn with rapidly progressive heart failure due to thrombus formation on the tricuspid valve.

Infective Endocarditis Successfully Treated in Extremely Low Birth Weight Infants With Recombinant Tissue Plasminogen Activator

“…1 If the catheters are positioned within the heart, damage to the endocardium can induce the development of intracardial thrombi despite a normal heart structure. 3 In the presence of IE, it is frequently impossible to eliminate the infection with removal of the infected line and antibiotic treatment alone, and persisting sepsis, despite adequate treatment with appropriate antiinfective agents, is an indication for surgical intervention. The development of infected intracardiac vegetations (infective endocarditis [IE]) secondary to line infection exposes the infant to prolonged infection and the dissemination of septic emboli to distant organs.…”

Management of Preterm Infants with Intracardiac Thrombi

“…This might have some importance in the premature infant with physiologically low plasminogen and fibrinogen concentrations. [44] Amazingly, despite these advantages, tPA has only rarely been used in preterm infants with vena cava or intracardiac thrombosis (table I) [27,39,60] and it is only recently that two different groups reported the successful use of rt-PA in small series of neonates or preterm infants, respectively, with catheter-related thrombosis. [41,64] Bleeding complications were reported only by one group in a small number of patients.…”

“…Although no clinical trials of thrombolytic treatment in neonates have been reported, there are many case reports suggesting that thrombolytic treatment may be efficient in treating intracardiac thrombosis in neonates born at term and in preterm infants [20,[22][23][24][25]27,28,33,[37][38][39]41] (table I).…”

Management of a large organized intraatrial catheter-tip thrombus in a child with acquired immunodeficiency syndrome using escalating tissue plasminogen activator infusions

“…Large intraatrial thrombi, whether located on the endocardium or at the catheter tip, may result in major complications, such as acute superior vena cava obstruction, pulmonary embolization, endothelial injury, infective endocarditis, tricuspid valve insufficiency, or cardiopulmonary arrest (3)(4)(5). In cases in which the thrombus is large or complications occur, surgical removal of the catheter by atriotomy under cardiopulmonary bypass may become necessary (1,4).…”