Journal of Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2433-1783 Print ISSN: 2433-2720
Japanese Society of Pediatric Cardiology and Cardiac Surgery
Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of Pediatric Cardiology and Cardiac Surgery 6(1): 37-41 (2022)

Case ReportCase Report

Multidisciplinary Management of Massive Pulmonary Arterial Thrombosis after Early Complete Repair of Tetralogy of Fallot

1Department of Cardiac, Thoracic and Vascular Sciences, Pediatric and Congenital Cardiac Surgery Unit, University of Padua ◇ Padova, Italy

2Pediatric Cardiology, Department of Woman’s and Child’s Health, University of Padua ◇ Padova, Italy

受付日:2021年5月5日Received: May 5, 2021
受理日:2021年9月22日Accepted: September 22, 2021
発行日:2022年1月31日Published: January 31, 2022

We present a case of massive pulmonary arterial thrombosis that occurred in an infant, during the early postoperative period after complete surgical repair of a severe form of Tetralogy of Fallot. The patient required emergent circulatory support with veno-arterial extracorporeal membrane oxygenation immediately followed by percutaneous thrombus fragmentation and local thrombolysis, which enabled partial thrombus removal and hemodynamic stabilization. Subsequently, the patient was scheduled for urgent surgical thrombectomy and central pulmonary arterial enlargement plasty, with successive circulatory and clinical improvement. The etiology of this complication was suspected to be multifactorial; multiple surgeries, systemic inflammatory state, hypoplastic pulmonary arteries, and moderate prothrombotic state. A multidisciplinary collaboration between intensivists, cardiologists, and cardiac surgeons and a rationale and step-by-step clinical approach were paramount to face this rare life-threatening complication.

Key words: pulmonary thrombosis; ECMO; thrombectomy; Tetralogy of Fallot

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