165 ARTERIAL THROMBOLYSIS IN THE NEONATE BY RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR (rTPA)

Abstract

In two neonates, aortic thrombosis induced by arterial catheter was located in abdominal aorta extended to the right renal artery; one induced right leg cyanosis and the other was identified by echo control of aortic catheter. In the third neonate, left atrial thrombosis was induced by the tip of a wire, positioned in left atria during aortic valvuloplasty and showed by post catheterim 2D echo control. The fourth neonate showed asystole related to myocardial ischemia after flushing a catheter inadvertently positioned in ascending aorta. In this case rtPA was immediately infused into the catheter which was then withdrawn. The three other neonates received a bolus rtPA 0.1 mg/kg/10 min followed by 0.9 mg/kg/3 hours then heparin 100 Ul/kg/h.Aortic thrombosis were relieved and echo control showed total disappearance of aortic thrombus. Blood pressure and renal urography; control were normal two months latter. Lysis of left atrial thrombosis was successful after a second injection of rTPA after failure of the first dose. In the fourth case rtPA did not avoid infarct, cardiac hypokinetic state and heart failure. However three months later cardiac function and EKG were normal. Except in the third case where minor bleedings were present after the second dose, there was not adverse effect during rtPA therapy.This short series demonstrated a very safe and rapid efficient action of rtPA in the treatment of severe neonatal systemic thrombosis.