Neonatal and childhood right atrial thrombosis: recognition and a risk-stratified treatment approach

Abstract

Pediatric literature and guidelines of treatment options for right atrial thrombosis (RAT) are lacking; thus, this review summarizes the available literature on RAT in infants and children. Medline search identified 35 publications, with 27 prospective or retrospective case series included for data analysis. A total of 122 cases of RAT were identified. The mean age of patients is 3.58 years (n = 86) with a strong predominance in the neonatal and infancy period. Ninety-one percent of cases were found to be associated with central venous catheters, 40.8% are premature neonates, 27.2% are postcardiac surgery patients, and 19.2% have underlying malignancies. Gut failure with total parenteral nutrition given via the central venous catheters occurred in 45.6% of patients. The most frequent presenting symptoms are respiratory distress and arrhythmia, and 56.8% (42 of 74) were asymptomatic. Our study defined high-risk features on echocardiogram as large size, more than 2 cm in any dimension, pedunculated, mobile, or snake-shaped, and mobile. Our result confirmed there is significant difference in the mortality for the high-risk group (16.7%; three of 18) versus the low risk group (0%; n = 32; P = 0.0416). Moreover, none of the asymptomatic patients showed progression in disease or died. Asymptomatic and hemodynamically stable patients with RAT who are at low risk are associated with good prognosis irrespective of treatment. We recommended removal of central venous line if possible, with or without anticoagulation for this group of patients. Systemic anticoagulation therapy should be given to all high-risk or symptomatic RAT patients. Surgical thrombectomy or thrombolytic therapy carries significant risk and should be considered individually.

Antithrombotic Therapy in Neonates and Children

“…[261][262][263][264][265][266][267][268][269][270][271][272][273] There are no specifi c guidelines for the use of thrombectomy in children, but there is general consensus that the TE recurrence rate and risk of long-term vas-tive of whether the infant received no therapy, UFH, or LMWH, with ‫ف‬ 70% of affected kidneys having irreversible renal atrophy. 279 Approximately 20% of children had hypertension on long-term follow-up, and 3% of children developed chronic renal failure.…”

“…273,520 The epidemiology and risk associated with right atrial thrombosis appears to be different in children compared with adults. 273 The natural history appears to be resolution irrespective of therapy, and many children are asymptomatic. Risk stratifi cation based on clot size and mobility appears to be useful.…”

“…Risk stratifi cation based on clot size and mobility appears to be useful. 273,520 For low-risk patients with a clot , 2 cm in size, nonmobile, and attached to the atrial wall, not pedunculated or snake shaped, then removal of the CVAD with or without anticoagulation appears appropriate. For high-risk thrombosis cases, systemic anticoagulation should be offered.…”

Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report

“…In this case, screening for underlying causes of cryptogenic stroke with ultrasound of the lower extremities revealed venous thrombosis The most probable releasing factor (and causative) of this event was a few days previously reported, sport's related, minor lower extremity injury, a relationship supported by literature. [36].…”

“…In the incident of right atrial thrombus, different treatment modalities are reported such as surgical thrombectomy, thrombolysis, anticoagulation therapy or observation only, the choice of which depended mainly on underlying etiology [36].…”