Endovascular treatment of near-fatal neonatal superior vena cava syndrome.
OBJECTIVE
We describe the endovascular management of an 8-wk-old previously healthy female who developed superior vena cava syndrome secondary to Pseudomonas septic shock and disseminated intravascular coagulation. Doppler ultrasound confirmed near-total thrombotic occlusion of the superior vena cava and right internal jugular vein. She was taken emergently for cardiac catheterization, which confirmed the large superior vena cava thrombus extending into the right internal jugular vein and innominate vein with almost complete occlusion of the innominate vein. The superior vena cava to right atrium gradient was 14 mm Hg with very little antegrade flow into the right atrium, right femoral artery occlusion, and branch pulmonary artery emboli. Intervention involved serial balloon dilation inflations across the superior vena cava and innominate vein with improvement in the superior vena cava to right atrium gradient to 5 mm Hg and significant improvement in left ventricular function. Anticoagulation included heparin infusion for 48 hrs followed by enoxaparin for 1 month, alteplase for 48 hrs, eptifibatide (glycoprotein IIb/IIIa inhibitor) for 9 days followed by aspirin.


METHODS
Chart review. Case reports are exempt from approval of our Institutional Review Board.


METHODS
None.


METHODS
None.


RESULTS
None.


CONCLUSIONS
Daily head ultrasounds were performed without evidence of intracranial hemorrhage. All thromboses resolved within 3 wks. Her organ function recovered and she was discharged to home. The etiology of her colitis is still unknown. At 9-month follow-up, she was doing well with no residual organ dysfunction.
Division of Pediatric Critical Care , Palmetto Health Children's Hospital, University of South Carolina School of Medicine, Columbia, SC, USA. ElizabethH.Mack@palmettohealth.org
Elizabeth H
EH
Mack
Derek S
DS
Wheeler
Russel
R
Hirsch
D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D011549:Pseudomonas / Q000302:isolation & purification; D011552:Pseudomonas Infections / Q000150:complications; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000601:surgery*; D013927:Thrombosis / Q000503:physiopathology* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*
D000925:Anticoagulants