Occlusive aortic arch thrombus in a preterm neonate

Abstract

Objective: To present the case of an extremely preterm infant with occlusive aortic arch clot managed with low-risk therapy.

Data source: Case details were obtained from medical records and echocardiographic images from Excelera database.

Study selection: Preterm infant with occlusive clot in the aortic arch.

Data extraction and synthesis: Demographic details (gestation age and birthweight), clinical and biochemical data (blood pressure, oxygen saturation, urine output, lactate levels, and coagulation profile) were obtained from medical records. A female infant was born at 28 wks gestation and had umbilical catheters inserted in satisfactory positions. On day 6, pre- and postductal oxygen saturation differences, a significantly higher blood pressure on right arm, and weak pulses were noted. Echocardiogram revealed an occlusive thrombus in the aortic arch distal to the innominate artery, extending into the carotid artery with retrograde flow in the left internal carotid and subclavian arteries. The distal aortic circulation was supported by ductus arteriosus shunting bidirectionally. Intravenous prostaglandin E and heparin were started, the latter was later replaced by enoxaparin. Serial echocardiograms over next 3 mos showed complete resolution of the thrombus.

Conclusions: Neonatal aortic arch thrombus is extremely rare with only 3 cases previously reported--all in term infants. Therapeutic options include anticoagulation, thrombolytic therapy, and thrombectomy. The risk/benefit ratio for anticoagulation and thrombolytic therapy is unknown and must be individualized. This preterm infant was managed with low-risk therapy and had an optimal outcome.