title: Successful pulmonary embolectomy of a saddle pulmonary thromboembolism in a preterm neonate.
abstract: Symptomatic pulmonary thromboembolism (PTE) is rare in neonates, and the diagnosis is often made only postmortem. The true incidence is probably underestimated because of its varying presentations, ranging from mild respiratory distress to acute right-heart failure and cardiovascular collapse. We report a sudden cardiorespiratory collapse on day 10 of life in a preterm neonate who was subsequently diagnosed as having a saddle pulmonary embolus. The patient underwent an emergency surgical embolectomy as a salvage procedure. Considering the potentially lethal complications of PTE, neonatologists and pediatricians should maintain a high degree of suspicion in infants with sudden inexplicable deterioration in cardiorespiratory status. Surgical removal of the thrombus is an invasive procedure and potentially carries a high mortality rate. Two term neonatal survivors of surgical intervention have been reported in the medical literature so far. However, we believe that this is the first documented preterm neonatal survivor after surgical intervention for a massive saddle PTE.
authors.affiliation: Divisions of Neonatology, Department of Paediatrics;
authors.forename: Kaarthigeyan
authors.initials: K
authors.lastname: Kalaniti
authors.affiliation: Cardiovascular Surgery, Department of Surgery;
authors.forename: Mauro
authors.initials: M
authors.lastname: Lo Rito
authors.affiliation: Cardiovascular Surgery, Department of Surgery; The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hickey
authors.affiliation: The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Cardiac Critical Care, Department of Critical Care Medicine; Cardiology, Department of Paediatrics; ben.sivarajan@sickkids.ca.
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
mesh_terms: D017128:Embolectomy; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D008297:Male; D011655:Pulmonary Embolism / Q000601:surgery*; D012074:Remission Induction
keywords: cyanotic; infant; neonate; preterm; pulmonary artery; saddle embolus; thrombus