Skip to main content

Advertisement

SpringerLink
Log in

Outcome of Cardiac Thrombi in Infants

  • Original
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Use of central lines in the neonatal intensive care unit (NICU) has led to the formation of intracardiac thrombi. A paucity of data exists on the management of neonatal cardiac thrombi, with the few reported cases focusing on outcomes following thrombolytic therapy. This study was undertaken to evaluate the outcome of cardiac thrombi in neonates who do not receive thrombolytic therapy. Nineteen patients younger than 3 months of age diagnosed with cardiac thrombi were included. All 19 patients had a central line. Management consisted of a combination of antibiotics and low-molecular-weight heparin (n = 16) or surgical removal (n = 2). In one case, no treatment was instituted. One patient was lost to follow-up after partial resolution of the thrombus. Complete thrombus resolution occurred in 18 patients, 9 with negative blood cultures and 9 with positive blood cultures. It took longer for resolution of thrombi associated with positive blood cultures than for sterile thrombi. No patient had evidence of thrombus embolization. From these data we concluded that the natural history of cardiac thrombi is resolution. Infected thrombi require more prolonged therapy. Surgery is seldom required and thrombolytics are not usually necessary for clot resolution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alkalay AL, Mazkereth R, Santulli T Jr, Pomerance JJ (1993) Central venous line thrombosis in premature infants: a case management and literature review. Am J Perinatol 10(4):323–326

    Article  PubMed  CAS  Google Scholar 

  2. De Godoy JM, de Marchi CH, Silva MG, Carvalho MC, Moscardini A, Tonet T (2002) Thrombus in the left ventricle of a newborn. J Pediatr 141(1):141

    Article  PubMed  Google Scholar 

  3. De Schepper J, Hachimi-Idrissi S, Cham B, et al. (1993) Diagnosis and management of catheter-related infected intracardiac thrombosis in premature infants. Am J Perinatol 10(1):39–42

    PubMed  Google Scholar 

  4. Dix D, Andrew M, Marzinotto V, et al. (2000) The use of low molecular weight heparin in pediatric patients: a prospective cohort study. J Pediatr 136(4):439–445

    Article  PubMed  CAS  Google Scholar 

  5. Dunaway KK, Gal P, Ransom JL (2000) Use of enoxaparin in a preterm infant. Ann Pharmacother 34(12):1410–1413

    Article  PubMed  CAS  Google Scholar 

  6. Edstrom CS, Christensen RD (2000) Evaluation and treatment of thrombosis in the neonatal intensive care unit. Clin Perinatol 27(3):623–641

    Article  PubMed  CAS  Google Scholar 

  7. Ekelund H, Hedner U, Nilsson IM (1970) Fibrinolysis in newborns. Acta Paediatr Scand 59(1):33–43

    Article  PubMed  CAS  Google Scholar 

  8. Ferrari F, Vagnarelli F, Gargano G, Roversi MF, Biagioni O, Ranzi A (2001) Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator. Arch Dis Child Fetal Neonatal Ed 85(1):F66–F69

    Article  PubMed  CAS  Google Scholar 

  9. Fleming RE, Barenkamp SJ, Jureidini SB (1998) Successful treatment of a staphylococcal endocarditis vegetation with tissue plasminogen activator. J Pediatr 132(3):535–537

    Article  PubMed  CAS  Google Scholar 

  10. Giuffre B, Compagnoni G, Farina C, Mosca F (1998) Successful use of tissue plasminogen activator (t-PA) in catheter-related intracardiac thrombi of two premature infants. Acta Paediatr 87(6):695–698

    Article  PubMed  CAS  Google Scholar 

  11. Haddad W, Idowu J, Georgeson K, Bailey L, Doroshow R, Pickham N (1986) Septic atrial thrombosis. A potentially lethal complication of Broviac catheters in infants. Am J Dis Child 140(8):778–780

    PubMed  CAS  Google Scholar 

  12. Hanseus K, Bjorkhem G (1995) Left ventricular thrombosis during infancy: report of two cases. Pediatr Cardiol 16(4):182–185

    PubMed  CAS  Google Scholar 

  13. Hartmann J, Hussein A, Trowitzsch E, Becker J, Hennecke KH (2001) Treatment of neonatal thrombus formation with recombinant tissue plasminogen activator: six years experience and review of the literature. Arch Dis Child Fetal Neonatal Ed 85(1):F18–F22

    Article  PubMed  CAS  Google Scholar 

  14. Havill JH (1975) Central venous thrombosis following central venous catheterisation and parenteral nutrition: case report. NZ Med J 81(539):420–422

    CAS  Google Scholar 

  15. Johnson DE, Bass JL, Thompson TR, Foker JE, Speert DP, Kaplan EL (1981) Candida septicemia and right atrial mass secondary to umbilical vein catheterization. Am J Dis Child 135(3):275–277

    PubMed  CAS  Google Scholar 

  16. Klinger G. Hellmann J. Daneman A (2000) Severe aortic thrombosis in the neonate: successful treatment with low-molecular-weight heparin: two case reports and review of the literature. Am J Perinatol 17(3):151–158

    Google Scholar 

  17. Levitas A, Zucker N, Zalzstein E, Sofer S, Kapelushnik J, Marks KA (2003) Successful treatment of infective endocarditis with recombinant tissue plasminogen activator. J Pediatr 143(5):649–652

    Article  PubMed  CAS  Google Scholar 

  18. Lumb PD (1993) Complications of central venous catheters. Crit Care Med 21(8):1105–1106

    Article  PubMed  CAS  Google Scholar 

  19. Mahony L, Snider AR, Silverman NH (1981) Echocardiographic diagnosis of intracardiac thrombi complicating total parenteral nutrition. J Pediatr 98(3):469–471

    Article  PubMed  CAS  Google Scholar 

  20. Marks KA, Zucker N, Kapelushnik J, Karplus M, Levitas A (2002) Infective endocarditis successfully treated in extremely low birth weight infants with recombinant tissue plasminogen activator. Pediatrics 109(1):153–158

    Article  PubMed  Google Scholar 

  21. Martinez-Tallo E, Campo F, Delgado M, Marfil S, Agulla E (1997) Thrombus in right atrium in two infants successfully treated with tissue plasminogen activator. Pediatr Emerg Care 13(1):37–39

    Article  PubMed  CAS  Google Scholar 

  22. Massicotte P, Adams M, Marzinotto V, Brooker LA, Andrew M (1996) Low-molecular-weight-heparin in pediatric patients with thrombotic disease: a dose finding study. J Pediatr 128(3):313–318

    Article  PubMed  CAS  Google Scholar 

  23. Mehta S, Connors AF, Danish EH, Grisoni E (1992) Incidence of thrombosis during central venous catheterization of newborns: a prospective study. J Pediatr Surg 27(1):18–22

    Article  PubMed  CAS  Google Scholar 

  24. Mendoza GJ, Soto A, Brown EG, Dolgin SE, Steinfeld L, Sweet AY (1986) Intracardiac thrombi complicating central parenteral nutrition: resolution without surgery or thrombolysis. J Pediatr 108:610–613

    Article  PubMed  CAS  Google Scholar 

  25. Michaels LA, Gurian M, Hegyi T, Drachtman RA (2004) Low molecular weight heparin in the treatment of venous and arterial thromboses in the premature infant. Pediatrics 114(3):703–707

    Article  PubMed  Google Scholar 

  26. Monagle P (2004) Anticoagulation in the young. Heart 90(7):808–812

    Article  PubMed  Google Scholar 

  27. Monagle P, Chan A, Massicotte P, Chalmers A, Michelson AD (2004) Antithrombotic therapy in children: the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):S645–S687

    Article  Google Scholar 

  28. Obaid L, Byrne PJ, Cheung PY (2004) Compartment syndrome in an ELBW infant receiving low-molecular-weight heparins. J Pediatr 144(4):549

    Article  PubMed  Google Scholar 

  29. Peters M, ten Cate JW, Koo LH, Breederveld C. (1984) Persistent antithrombin III deficiency: risk factor for thromboembolic complications in neonates small for gestational age. J Pediatr 105(2):310–314

    Article  PubMed  CAS  Google Scholar 

  30. Picarelli D, Surraco J, Zuniga C, et al. (2000) Surgical management of active infective endocarditis in a premature neonate weighing 950 grams. J Thorac Cardiovasc Surg 119(2):380–381

    Article  PubMed  CAS  Google Scholar 

  31. Pliam MB, McGough EC, Nixon GW, Ruttenberg HD (1979) Right atrial ball-valve thrombus: a complication of central venous alimentation in an infant. Diagnosis and successful surgical management of a case. J Thorac Cardiovasc Surg 78(4):579–582

    PubMed  CAS  Google Scholar 

  32. Pugh KG, Jureidini SB, Ream R, Syamasundar RP, Dossier J (2002) Successful thrombolytic therapy of pulmonary embolism associated with urosepsis in an infant. Pediatr Cardiol 23(1):77–79

    Article  PubMed  CAS  Google Scholar 

  33. Schiff DE, Stonestreet BS (1993) Central venous catheters in low birth weight infants: incidence of related complications. J Perinatol 13(2):153–158

    PubMed  CAS  Google Scholar 

  34. Streif W, Goebel G, Chan AK, Massicotte MP (2003) Use of low molecular mass heparin (enoxaparin) in newborn infants: a prospective cohort study of 62 patients. Arch Dis Child Fetal Neonatal Ed 88(5):F365–F370

    Article  PubMed  CAS  Google Scholar 

  35. Tanke RB, van Megen R, Daniels O (1994) Thrombus detection on central venous catheters in the neonatal intensive care unit. Angiology 45(6):477–480

    Article  PubMed  CAS  Google Scholar 

  36. Torres-Valdivieso MJ, Cobas J, Barrio C, et al. (2003) Successful use of tissue plasminogen activator in catheter-related intracardiac thrombus of a premature infant. Am J Perinatol 20(2):91–96

    Article  PubMed  CAS  Google Scholar 

  37. Van Overmeire B, Van Reempts PJ, Van Acker KJ (1992) Intracardiac thrombus formation with rapidly progressive heart failure in the neonate: treatment with tissue type plasminogen activator. Arch Dis Child 67(Spec No 4):443–445

    PubMed  Google Scholar 

  38. Weinschenk N, Pelidis M, Fiascone J (2001) Combination thrombolytic and anticoagulant therapy for bilateral renal vein thrombosis in a premature infant. Am J Perinatol 18(5):293–297

    Article  PubMed  CAS  Google Scholar 

  39. Wesley JR, Keens TG, Miller SW, Platzker AC (1978) Pulmonary embolism in the neonate: occurrence during the course of total parenteral nutrition. J Pediatr 93(1):113–115

    Article  PubMed  CAS  Google Scholar 

  40. Zuasnabar A, Bejar R, Sherman F, Mannino F (1991) An interesting case presentation: ultrasound diagnosis of primary atrial thrombosis associated with brain infarctions. J Perinatol 11(1):73–76

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA

    Edgard A. Bendaly

  2. Department of Pediatric Cardiology, University of California, Irvine, CA, USA

    Anjan S. Batra

  3. Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA

    Eric S. Ebenroth & Roger A. Hurwitz

Authors
  1. Edgard A. Bendaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anjan S. Batra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric S. Ebenroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roger A. Hurwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edgard A. Bendaly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bendaly, E.A., Batra, A.S., Ebenroth, E.S. et al. Outcome of Cardiac Thrombi in Infants. Pediatr Cardiol 29, 95–101 (2008). https://doi.org/10.1007/s00246-007-9036-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-007-9036-8

Keywords

Search

Navigation