Pediatr Cardiol 13:240, 1992
Pediatric Cardiology 9 Springer-VerlagNew York Inc. 1992
Letters to the Editor Inferior V e n a Cava Thrombus in Infants We read the recent article by Kgtd~r et al. [1] on right heart thrombus in infants and children with much interest. Infants with TGA seem to be at a particular risk of developing thrombosis, especially after balloon atrioseptostomy, as we recently observed. A newborn with simple TGA underwent catheterization and balloon atrioseptostomy on the third day of extrauterine life. The catheter was introduced through the umbilical vein. During the examination the patient developed an episode of bradycardia of 40 beats/min, which responded to therapy within 8 min. After the catheterization the patient had to be ventilated for 24 h. Echocardiography 8 days after atrioseptostomy revealed a thrombus in the inferior vena cava (IVC). Its length was about 8 cm, and its diameter about 8-10 mm. The cardiac end was thicker and protruded into the right atrium, moving with the blood flow (Fig. 1). Follow-up two-dimensional echocardiography demonstrated a gradual decrease in size. At the age of 4 months its size was 2-3 mm at the entry of the IVC into the right atrium (Fig. 2). The patient underwent a Senning repair at 5 months of age. During surgery no thrombus was found in the IVC. This case shows that even large thrombi developing after catheteri-
Fig. 2. Remaining small IVC thrombus (arrows), 4 months after balloon atrioseptostomy.
zation of the heart and great vessels may resolve spontaneously with time. The diagnosis of IVC thrombosis was not made clinically. In accordance with K~id~iret al. [I], we would emphasize the value of two-dimensional echocardiography in the detection of an atrial thrombus. In 1990, Geva et al. [2] underlined the usefulness of two-dimensional echocardiography in this diagnosis. As to the etiology of the thrombosis in our case, decreased flow due to bradycardia may have played a particular role. As to treatment, we thought the risk of surgery to be fairly high. Streptokinase therapy would also have been risky and might have come too late anyway.
References 1. Kfidfir K, Hartyfinszky I, Kirfily L, et al (1991) Right heart thrombus in infants and children. Pediatr Cardiol 12:24-27 2. Geva T, Frand M, Benjamin P, Hegesh J (1990) Cerebral embolization from an inferior vena cava thrombus in tetralogy of Fallot. Pediatr Cardiol 11:44-46
H.-J. H~iusler P. Schneider Fig. 1. IVC thrombus protruding into the right atrium, 8 days after balloon atrioseptostomy. LA, left atrium; RA, right atrium; SVC, superior vena cava.
Department of Paediatric Cardiology' University Children's Hospital University of Leipzig Leipzig, Federal Republic of Germany
Pediatric Cardiology 9 Springer-VerlagNew York Inc. 1992
Letters to the Editor Inferior V e n a Cava Thrombus in Infants We read the recent article by Kgtd~r et al. [1] on right heart thrombus in infants and children with much interest. Infants with TGA seem to be at a particular risk of developing thrombosis, especially after balloon atrioseptostomy, as we recently observed. A newborn with simple TGA underwent catheterization and balloon atrioseptostomy on the third day of extrauterine life. The catheter was introduced through the umbilical vein. During the examination the patient developed an episode of bradycardia of 40 beats/min, which responded to therapy within 8 min. After the catheterization the patient had to be ventilated for 24 h. Echocardiography 8 days after atrioseptostomy revealed a thrombus in the inferior vena cava (IVC). Its length was about 8 cm, and its diameter about 8-10 mm. The cardiac end was thicker and protruded into the right atrium, moving with the blood flow (Fig. 1). Follow-up two-dimensional echocardiography demonstrated a gradual decrease in size. At the age of 4 months its size was 2-3 mm at the entry of the IVC into the right atrium (Fig. 2). The patient underwent a Senning repair at 5 months of age. During surgery no thrombus was found in the IVC. This case shows that even large thrombi developing after catheteri-
Fig. 2. Remaining small IVC thrombus (arrows), 4 months after balloon atrioseptostomy.
zation of the heart and great vessels may resolve spontaneously with time. The diagnosis of IVC thrombosis was not made clinically. In accordance with K~id~iret al. [I], we would emphasize the value of two-dimensional echocardiography in the detection of an atrial thrombus. In 1990, Geva et al. [2] underlined the usefulness of two-dimensional echocardiography in this diagnosis. As to the etiology of the thrombosis in our case, decreased flow due to bradycardia may have played a particular role. As to treatment, we thought the risk of surgery to be fairly high. Streptokinase therapy would also have been risky and might have come too late anyway.
References 1. Kfidfir K, Hartyfinszky I, Kirfily L, et al (1991) Right heart thrombus in infants and children. Pediatr Cardiol 12:24-27 2. Geva T, Frand M, Benjamin P, Hegesh J (1990) Cerebral embolization from an inferior vena cava thrombus in tetralogy of Fallot. Pediatr Cardiol 11:44-46
H.-J. H~iusler P. Schneider Fig. 1. IVC thrombus protruding into the right atrium, 8 days after balloon atrioseptostomy. LA, left atrium; RA, right atrium; SVC, superior vena cava.
Department of Paediatric Cardiology' University Children's Hospital University of Leipzig Leipzig, Federal Republic of Germany
