Atrioventricular thrombus in a 14-year-old patient: a case report
© Besogul et al; licensee BioMed Central Ltd. 2010
Received: 30 December 2008
Accepted: 2 February 2010
Published: 2 February 2010
Right atrioventricular thrombus was diagnosed by echocardiography in a 14-year-old boy. Thrombus was reached through the right ventricle to the pulmonary artery and it was caused to tricuspit valve insufficiency. Surgical thrombectomy was performed and, he was treated with oral anticoagulation in postoperative period.
Atrioventricular thrombus are relatively rare in the pediatric population, but when present they are a potential source of significant morbidity and mortality. Echocardiography is a widely accepted method to detect intracardiac thrombosis. The echocardiographic appearance of intracardiac thrombus is a mainly apical mass with a defined border to cavum and myocardium [2–5] The treatment of intracardiac thrombus has been surgical thrombectomy or thrombolytic agents such as tissue plasminogen activator, streptokinase, or urokinase as well as anticoagulants such as heparin or warfarin.
Intracardiac thrombus, although relatively rare in the pediatric age group, have been increasing in recent years [6–8]. Pediatric intracardiac thrombus are most commonly diagnosed in patients with dilated cardiomyopathy and in patients status post Fontan operation. There is a male predominance. The etiology in pediatric patients has yet to be clearly defined. Most pediatric studies have focused on underlying hematologic abnormalities, such as deficiencies in protein C and Factor V, that could predispose one to have an intracardiac thrombus [9, 10]. Right heart thrombus occurs in association with the presence of central venous catheters, vegetations due to endocarditis, polycytaemia, congenital heart defects, respiratory distress syndrome and persistent foetal circulation [11, 12]. They have been shown to cause superior vena cava syndrome, occlusion of the tricuspit valve, and valvuler insufficiency with rapidly progressive heart failure. Additionally, main risk of the patients consists in unpredictable pulmonary embolization. Ebato et al, reported that the patients have presented with symptoms of cerebral embolism and pulmonary embolism. The traditional therapy for intracardiac thrombus in pediatric patients has been surgical thrombectomy. In the largest pediatric study to date Ozkutlu et al, described the outcomes of 11 patients with intracardiac thrombus, 5 of whom underwent thrombectomy. Thrombolytics such as tissue plasminogen activator, streptokinase, or urokinase have been used routinely for the treatment of neonatal thrombus [15, 16]. The optimal treatment modalities for children with intracardiac thrombus are not known. Information on management is limited to case reports and small case series. Moreover, spontaneous regression of intracardiac thrombus has been previously reported. There was a tendency for smaller cardiac thrombus to resolve with medical therapy and for embolization to occur in patients with large thrombi. We have performed surgical embolectomy because of the large thrombus in the atrium and ventricle.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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