Thrombolysis of a modified Blalock-Taussig shunt with recombinant tissue plasminogen activator in a newborn infant with pulmonary atresia and ventricular septal defect.
A 10 day old infant with pulmonary atresia, ventricular septal defect, and collateral pulmonary blood supply through a left sided ductus arteriosus developed complete shunt thrombosis four days after the creation of a modified Blalock-Taussig shunt. Recombinant tissue plasminogen activator was given locally into the proximal end of the shunt as two bolus injections of 0.1 mg/kg and two bolus injections of 0.2 mg/kg over 10 minutes, followed by a continuous infusion of 1.4 mg/kg/day for 16 hours and 0.7 mg/kg/day for 18 hours with systemic low dose heparin 5 IU/kg/h. This resulted in complete clot dissolution and reperfusion without haemorrhagic complications and without laboratory signs of systemic fibrinolytic activation.
Ries
M
M
Department of Paediatrics, University of Erlangen-Nuernberg, Germany.
Singer
H
H
Hofbeck
M
M
D000015:Abnormalities, Multiple / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical; D004374:Ductus Arteriosus, Patent / Q000150:complications; D006345:Heart Septal Defects, Ventricular / Q000150:complications*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D018633:Pulmonary Atresia / Q000150:complications*; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator