Tissue plasminogen activator treatment of bilateral pulmonary emboli in a pediatric patient supported with a ventricular assist device

Abstract

Bleeding and thrombosis are well-known potential complications of VAD support. We present a pediatric patient who developed massive bilateral pulmonary emboli while on BiVAD support that was successfully treated with intravenous tPA and bridged to heart transplant.

Extended recovery of cardiac function after severe infantile cardiomyopathy presentation of Barth syndrome

“…This is important because the prevailing description of outcomes for infants with severe cardiomyopathy and Barth syndrome in the medical literature is commonly of death, need for mechanical circulatory support, and/or heart transplantation. 8,12,[14][15][16][17] During the timeframe that these children were cared for at our center (December 2006-present) we had no other individuals with Barth syndrome die. During his time we also cared for a 3-year-old, not reported herein, with Barth syndrome (TAFAZZIN c.647G > T) who had decreased cardiac function and medically treated heart failure upon outpatient transfer of care to our center who shortly thereafter required ventricular assist device support and subsequent heart transplantation.…”

“…In this series, we present five children with Barth syndrome who presented under age 2 with symptomatic heart failure who had extended responses to medical heart failure therapy with resolution of heart failure symptoms and near normalization to normalization of LV size and systolic function. This is important because the prevailing description of outcomes for infants with severe cardiomyopathy and Barth syndrome in the medical literature is commonly of death, need for mechanical circulatory support, and/or heart transplantation 8,12,14–17 . During the timeframe that these children were cared for at our center (December 2006–present) we had no other individuals with Barth syndrome die.…”

ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

“…In setting of ischemic stroke with evidence of vessel occlusion and large territory involvement, thrombectomy or intravenous tPA may be potential options for intervention. [132][133][134] For patients with paracorporeal VAD, pump exchange should be considered if there is evidence of a clot. Anticoagulation management after VAD-related CVA is challenging.…”