[Chronic cor pulmonale and refractory hypoxemia following pulmonary embolism in a six-month-old infant: surgical management by thromboendarterectomy]

Abstract

A diagnosis of pulmonary embolism is uncommon in the infant and the child, and chronic cor pulmonale secondary to pulmonary embolism is an even rarer occurrence.

Case report: In this study, a case of pulmonary embolism in a 6-month-old male infant has been reported. His past history included preterm birth, and severe bronchopulmonary dysplasia, with prolonged oxygen dependency. The positive diagnosis was based on cardiac ultrasound examination, with the direct imaging of a right pulmonary arterial thrombus. Surgical thromboendarterectomy was performed, with a long-term favorable outcome.

Conclusion: After excluding from the diagnosis those hemostatic disorders known to be thrombogenic, the most likely hypothesis was retained, i.e., that it was catheter-related. A central venous catheter had been inserted during the neonatal period, and was probably responsible for the embolism. The clinical characteristics and the diagnostic and therapeutic aspects of chronic postembolic cor pulmonale have been discussed in the light of the present findings.