Introduction : Intracardiac thrombosis is rare in neonates. Mostly thrombi occur in right heart and are associated with central venous catheter(CVC), congenital heart disease, sepsis and peripartum asphyxia. Anticoagulants, fibrinolytic drugs or surgical removal are used for the treatment of intracardiac thrombi in neonates, but are still controversial. We report that CVC-related right atrial(RA) thrombus were treated successfully with tissue plasminogen activator(t-PA) and heparin in two neonates with transposition of the great arteries(TGA).
Cases : The first neonate, aged 22 days, developed a RA thrombus(2x1.2 cm) following arterial switch operation(ASO) with CVC insertion. The second, aged 32days, developed a RA thrombus(1x1.2cm) following ASO with CVC insertion. Both were treated by combination with t-PA and heparin. T-PA was given intravenously in 6 hour infusion with daily dosage being steadily increased (0.10~0.25 mg/kg/h) and heparin was continuously infused at 50 U/kg/h. We treated for 14 days with daily echocardiography and echocardiography showed progressive thrombus reduction. During and after treatment, major bleeding was not.
Conclusion : T-PA and heparin was safe and effective in neonates with CVC related RA thrombus.