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Spontaneous Aortic Thrombosis i6 a Neonate Presenting as Coarctation.pptx

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Title: Spontaneous Aortic Thrombosis i6 a Neonate Presenting as Coarctation.pptx


1
Spontaneous Aortic Thrombosis i6 a Neonate
Presenting as Coarctation
  • By Dr. PATRICIA ANN PENKOSKE, M.D.

2
  • ABSTRACT Spontaneous aortic thrombosis in the
    neonate is a rare entity of uncertain etiology
    with a high mortality. To our knowledge, this is
    the first report of a newborn surviving surgical
    treatment of spontaneous thrombosis of the
    thoracic aorta.
  • Aortic thrombosis in neonates is rare and usually
    related to umbilical artery catheterization.
    Spontaneous aortic thrombosis in a neonate has
    been described 14. The location is more
    commonly abdominal than thoracic. Management has
    been varied and usually unsuccessful. Spontaneous
    thrombosis of the thoracic aorta has been lethal
    in the cases reported 4, 51. We report the case
    of a newborn with spontaneous thrombosis of the
    thoracic aorta who was treated surgically and
    survived.

3
  • This 2,810-gm, 38-week-gestation male infant was
    born to a 33-year-old gravida I1 para I mother.
    Prenatal history was normal until the day of
    delivery when she was seen with absent fetal
    movements. Emergency cesarean section was
    performed. The infant had marked respiratory
    depression, with Apgar scores of 4 and 8, and
    required resuscitation.

4
  • The skin appeared mottled but pink. Heart rate
    was 130 beats min, respiratory rate was 64/min,
    and blood pressures were 106194 mm Hg in the
    right arm, 84/66 mm Hg in the left arm, 36/25 mm
    Hg in the right leg, and 48/31 mm Hg in the left
    leg. Precordial impulse was increased, and the
    liver edge was 3 cm below the right costal
    margin. The left femoral pulse was palpable but
    decreased. The right femoral pulse was not
    palpable. A Grade 216 systolic ejection murmur
    was audible at the heart base. Umbilical arterial
    catheterization had not been performed. Arterial
    blood gases were pH 7.27, carbon dioxide tension
    was 48.5 mm Hg, oxygen tension was 37 mm Hg, and
    hematocrit was 66.5. Chest radiograph showed
    moderate cardiomegaly and mild pulmonary
    plethora.

5
  • Two-dimensional echocardiography demonstrated a
    structurally normal heart but the almost complete
    narrowing of the aorta just above the level of a
    persistent ductus arteriosus. Left ventricular
    contractility was markedly reduced, with a
    shortening fraction of 0.13 (normal, 0.2tL0.50).
    An infusion of prostaglandin El, 0.05 mg/kg/min
    was started. Cardiac catheterization was
    performed. Left ventricular pressure was 86/12 mm
    Hg, and the descending aortic pressure was 32/26
    mm Hg. Figure 1 shows the posteroanterior view of
    the aortic arch from the left ventricular
    angiogram. There was the obstruction in the right
    subclavian artery at the level of its exit from
    the thorax and a severe stenosis of the left the
    subclavian artery with a thrombus within this
    vessel. The lateral view (Fig 2) demonstrated an
    obstruction to flow distal to the left subclavian
    artery.

6
  • In the operating room, the aortic arch was
    visualized through a left-sided thoracotomy. The
    aorta was opened and an organized, partially
    adherent thrombus was removed. The thrombus
    originated just distal to the left carotid artery
    and sent a tail into the left subclavian artery,
    which was hypoplastic. The ductus arteriosus was
    patent, with no thrombus in its lumen. There was
    no visible external coarctation or posterior
    shelf internally. The aorta was closed with a
    Gore-Tex patch to prevent narrowing from surgical
    scamng at the incision line. Pathological study
    demonstrated a clot measuring 6 x 5 x 4 mm that
    consisted of fibrin and foci of calcification.

7
  • The platelet count fell gradually to 34,000/1 on
    the fourth postoperative day but then returned to
    normal. Prothrombin time was 13.1 to 13.5 seconds
    (normal, 1S30 seconds). Partial thromboplastin
    time was 45 seconds on the second postoperative
    day (normal, 46-65 seconds). Protein C and
    antithrombin I11 levels were below normal
    protein C was 0.45 units (normal, 0.63-1.27
    units) and antithrombin I11 was 0.47 units
    (normal, 0.75-1.25 units).
  • Postoperatively, the left femoral pulse was
    normal. Signs of congestive heart failure
    resolved quickly. The right femoral pulse did not
    return, and an ischemic area developed on the tip
    of the right small toe. The rest of the limb was
    pink and well perfused. The right arm was
    intermittently cyanosed, and the pulse was
    absent. Heart size returned to normal by the
    fifth postoperative day. The infant has been
    followed up for six months and is developing
    normally and is receiving no medications.

8
  • Contact Us
  • Dr. Patricia Penkoske
  • About us Dr. Patricia Penkoske is experienced
    Cardiothoracic Surgeon and thoracic surgery
    doctor in Saint Louis, Missouri.
  • Address4944 Lindell Blvd, 4 West, St. Louis, Mo.
    63108
  • General Inquiries patricia.penkoske_at_gmail.com
  • Phone 314-753-5255
  • Citizenship USA, Landed Immigrant-Canada.
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