ORIGINAL ARTICLE

Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

Corresponding Author

Delaram Molkara MD

[email protected]

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Correspondence Delaram Molkara, MD, 3020 Children's Way, Rady Children's Hospital, San Diego, California, 92123, USA. Email: [email protected]Search for more papers by this author

Jose A. Silva Sepulveda MD,

Jose A. Silva Sepulveda MD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Thomas Do MD, MS,

Thomas Do MD, MS

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Christopher Davis MD, PhD,

Christopher Davis MD, PhD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Gregory P. Goldstein MD,

Gregory P. Goldstein MD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

John W. Moore MD, MPH,

John W. Moore MD, MPH

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Howaida G El-Said MD, PhD,

Howaida G El-Said MD, PhD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Delaram Molkara MD,

Corresponding Author

Delaram Molkara MD

[email protected]

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Correspondence Delaram Molkara, MD, 3020 Children's Way, Rady Children's Hospital, San Diego, California, 92123, USA. Email: [email protected]Search for more papers by this author

Jose A. Silva Sepulveda MD,

Jose A. Silva Sepulveda MD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Thomas Do MD, MS,

Thomas Do MD, MS

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Christopher Davis MD, PhD,

Christopher Davis MD, PhD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Gregory P. Goldstein MD,

Gregory P. Goldstein MD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

John W. Moore MD, MPH,

John W. Moore MD, MPH

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

Howaida G El-Said MD, PhD,

Howaida G El-Said MD, PhD

Rady Children's Hospital, San Diego, University of California, San Diego, California, USA

Search for more papers by this author

First published: 31 January 2017

https://doi.org/10.1111/chd.12432

Citations: 9

Share a link

Email
Wechat
Bluesky

Abstract

Objective

Neonatal coronary thrombosis is a rarely reported disorder, with variable outcomes described. This study assessed the feasibility and safety of an institutional protocol using tissue plasminogen activator (tPA) administration for the treatment of neonatal coronary artery thrombi.

Methods

They reviewed the outcome of three neonates with clinical evidence of myocardial infarction secondary to coronary thrombosis. All three underwent the tPA treatment protocol.

Results

The three described cases presented at 5 hours, 15 hours, and 10 days of life. The patients identified underwent the tPA protocol at least once. There was clinical evidence of improvement in coronary flow, as well as demonstration of increased left ventricular function and decreased mitral regurgitation. No major adverse events occurred.

Conclusion

Thrombolytic therapy with this tPA protocol may be safe and effective in treating neonates with coronary thrombosis.

Supporting Information

References

1 Ravich RM, Rosenblatt P. Myocardial infarction in the newborn infant. J Pediatr. 1947; 31(3): 266–273.
10.1016/S0022-3476(47)80240-9
CAS PubMed Web of Science® Google Scholar
2 Rajesh GN, Sajeer K, Nair A, et al. Hammock mitral valve: a rare cause of congenital mitral regurgitation–a case report. Indian Heart J. 2014; 66(3): 370–371.
10.1016/j.ihj.2014.03.008
PubMed Google Scholar
3 Farooqi KM, Sutton N, Weinstein S, et al. Neonatal myocardial infarction: case report and review of the literature. Congenit Heart Dis. 2012; 7(6): E97-E102.
10.1111/j.1747-0803.2012.00660.x
PubMed Web of Science® Google Scholar
4 Boulton J, Henry R, Roddick LG, et al. Survival after neonatal myocardial infarction. Pediatrics. 1991; 88(1): 145–150.
10.1542/peds.88.1.145
CAS PubMed Web of Science® Google Scholar
5 Kudumula V, Mehta C, Stumper O, et al. Twenty-year outcome of anomalous origin of left coronary artery from pulmonary artery: management of mitral regurgitation. Ann Thorac Surg. 2014; 97(3): 938–944.
10.1016/j.athoracsur.2013.11.042
PubMed Web of Science® Google Scholar
6 Demirel G, Oguz SS, Celik IH, et al. Evaluation and treatment of neonatal thrombus formation in 17 patients. Clin Appl Thromb Hemost. 2011; 17(6): E46–E51.
10.1177/1076029610382653
PubMed Web of Science® Google Scholar
7 Bratincsak A, Moore JW, El-Said HG. Low dose tissue plasminogen activator treatment for vascular thrombosis following cardiac catheterization in children: a single center experience. Catheter Cardiovasc Interv. 2013; 82(5): 782–785.
10.1002/ccd.24521
PubMed Web of Science® Google Scholar
8 Abdurrahman L, Schwartz SM, Beekman RH., 3rd. Thrombotic occlusion of the main stem of the left coronary artery in a neonate. Cardiol Young. 1999; 9(2): 189–191.
10.1017/S1047951100008428
CAS PubMed Web of Science® Google Scholar
9 Tillett A, Hartley B, Simpson J. Paradoxical embolism causing fatal myocardial infarction in a newborn infant. Arch Dis Child Fetal Neonatal Ed. 2001; 85(2): F137–F138.
10.1136/fn.85.2.F137
CAS PubMed Web of Science® Google Scholar
10 Deutsch MA, Cleuziou J, Noebauer C, et al. Successful management of neonatal myocardial infarction with ECMO and intracoronary r-tPA lysis. Congenit Heart Dis. 2014; 9(5): E169–E174.
10.1111/chd.12117
PubMed Web of Science® Google Scholar
11 Cesna S, Eicken A, Juenger H, et al. Successful treatment of a newborn with acute myocardial infarction on the first day of life. Pediatr Cardiol. 2013; 34(8): 1868–1870.
10.1007/s00246-012-0417-2
CAS PubMed Web of Science® Google Scholar
12 Hallbergson A, Gillespie MJ, Dori Y. A case of neonatal myocardial infarction: left coronary artery thrombus resolution and normalisation of ventricular function by intracoronary low-dose tissue plasminogen activator. Cardiol Young. 2015; 25(4): 810–812.
10.1017/S1047951114001267
PubMed Web of Science® Google Scholar
13 Gault MH, Usher R. Coronary thrombosis with myocardial infarction in a newborn infant. N Engl J Med. 1960; 263: 379–382.
10.1056/NEJM196008252630803
CAS PubMed Web of Science® Google Scholar
14 Panteghini M, Agnoletti G, Pagani F, et al. Cardiac troponin T in serum as marker for myocardial injury in newborns. Clin Chem. 1997; 43(8 Pt 1): 1455–1457.
PubMed Web of Science® Google Scholar
15 Ramlogan SR, McKee D, Lofland GK, et al. Neonatal acute myocardial infarction of unknown etiology treated with surgical thrombectomy. Congenit Heart Dis. 2014; 9(5): E158–E162.
10.1111/chd.12115
PubMed Web of Science® Google Scholar
16 Cheah FC, Boo NY, Rohana J, et al. Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses. J Paediatr Child Health. 2001; 37(5): 479–482.
10.1046/j.1440-1754.2001.00700.x
CAS PubMed Web of Science® Google Scholar
17 Aydin B, Beken S, Dilli D, et al. Fibrinolytic therapy of thrombosis in 27 newborns followed-up in neonatal intensive care unit. Pediatr Hematol Oncol. 2013; 30(8): 705–716.
10.3109/08880018.2013.793756
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume12, Issue3

May/June 2017

Pages 270-274

This article also appears in:

Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

Abstract

Objective

Methods

Results

Conclusion

Supporting Information

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

Abstract

Objective

Methods

Results

Conclusion

Supporting Information

References

Citing Literature

References

Related

Information