Rheolytic mechanical thrombectomy for pulmonary artery thrombus in children with complex cyanotic congenital heart disease

Abstract

Acute thrombosis of the pulmonary arteries (PA) can occur during operative or catheter based interventions. This may have serious consequences especially in patients with palliated single ventricle physiology. Traditional therapy for PA thrombosis includes use of local or systemic thrombolytic therapy and surgical thrombectomy. Percutaneous transcatheter mechanical thrombectomy can be broadly divided into three categories based on their mechanisms of action: (a) mechanical fragmentation of the embolus using guide-wires, pigtail catheters, or balloons (flossing technique), (b) extraction using cup or basket devices, or (c) hydrodynamic fragmentation and aspiration of the embolus. Rheolytic thrombectomy using AngioJet system (Possis Medical, Minneapolis, MN) uses hydrodynamic thrombus fragmentation and aspiration technique, and provides an alternative solution in management of acute thrombosis. We report three patients with complex congenital heart disease of single ventricle physiology palliated by cavopulmonary anastomosis or central shunts and PA thrombosis treated with AngioJet system.