Cover Image: Pulmonary artery thrombosis in a premature child
R. Rauch, R. Kaulitz, and M. Hofbeck
University Hospital for Children and Adolescents, Tuebingen, Germany
Pulmonary artery thrombosis represents a rarity in prematures and infants. In the majority of cases, thrombosis of major arteries in neonates is associated either with i.v. catheters or systemic infections. We report on a premature infant of 36 weeks gestation, whose mother was smoking 50 cigarettes per day during pregnancy. Postpartum, respiratory insufficiency warranted mechanical ventilation for 3 days. Initial echocardiography suggested pulmonary hypertension. The child was referred to our centre at day 12. Echocardiography revealed complete thrombosis of the left pulmonary artery and partial thrombosis of the right, probably originating from a ductus arteriosus aneurysm. Screening for thrombophilia yielded normal results. The child was subjected to local thrombolysis (five bolus doses of recombinant plasminogen activator) during cardiac catheterization, followed by systemic application for 2 days. Perfusion improved significantly on both pulmonary arteries, particularly on the left side. The child was discharged 2 weeks after admission, while the ductus aneurysm had closed spontaneously. Follow-up examination at 12 months demonstrated persistent patency of the left pulmonary artery. Ductus arteriosus aneurysm is considered to be a rare and potentially fatal abnormality with progressive formation of thrombi between the third and tenth day of life. As in our patient, it typically inserts into the pulmonary artery from an unusual superior direction. The association of a ductus arteriosus aneurysm and maternal nicotine abuse may have led to thrombus formation and extension into the pulmonary arteries. Local application of recombinant plasminogen activator into the thrombus was effective in restoring patency of the occluded pulmonary arteries.
Figure legend
Upper left: Two-dimensional echocardiography (high parasternal short axis) demonstrates partial obstruction of the right (RPA) and complete obstruction of the left pulmonary artery (LPA) by a large (arrow) thrombus.
Lower left: Initial right ventricular angiography shows complete occlusion of the left pulmonary artery.
Upper right: Colour Doppler echocardiography following thrombolysis reveals patency of the pulmonary bifurcation and restored patency of left pulmonary artery.
Lower right: Repeat angiography following thrombolysis demonstrates patency of the left pulmonary artery. Note partial re-opening of a pulmonary ductus diverticulum (arrow).
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