초록접수 현황
| 19F-057 | 포스터 발표 |
Successful Surgical Management of Right Ventricular Thrombosis and Chronic Pulmonary Thromboembolism in a Child With Acute Lymphoblastic Leukemia
Jiyun Lee, Cheul Lee
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
Purpose : Acute lymphoblastic leukemia(ALL) is the most common malignancy in children. In children with ALL, the incidence of intracardiac thrombosis and pulmonary thromboembolism(PTE) is 1%. The pathogenesis of thrombosis in ALL is not fully understood, but it is affected by risk factors; malignancy, its treatment, and host. We present the case of a 9-year-old girl with ALL, right ventricular(RV) thrombosis, and PTE.
Methods : A 9-year-old girl presented with general weakness and sustained fever for 8days. The patient was diagnosed as T-cell ALL. Echocardiography and CT showed a large thrombus in RV and a separate thrombus obstructing the right lower pulmonary artery. Although urgent surgical removal of thrombus was necessary, surgery had to be delayed due to the high risk of bleeding and infection. Low-molecular-weight heparin was administered during the induction chemotherapy without significant resolution of thrombi.
Results : After complete remission with the induction chemotherapy, the patient underwent RV thrombectomy and pulmonary thromboendarterectomy. Pathology of the removed masses confirmed organizing thrombi. The child had no postoperative complication. Postoperative CT and echocardiography revealed no residual thrombus except for the minimal thrombus attached to tricuspid valve.
Conclusion : RV thrombosis and PTE in children with ALL are extremely rare, and to our knowledge, no surgical case has been reported to date. Surgical management of RV thrombosis and PTE in children with ALL is challenging due to the high risk of bleeding and infection. We have successfully performed RV thrombectomy and pulmonary thromboendarterectomy in a child with ALL just after completion of the induction chemotherapy without any postoperative complication.
Methods : A 9-year-old girl presented with general weakness and sustained fever for 8days. The patient was diagnosed as T-cell ALL. Echocardiography and CT showed a large thrombus in RV and a separate thrombus obstructing the right lower pulmonary artery. Although urgent surgical removal of thrombus was necessary, surgery had to be delayed due to the high risk of bleeding and infection. Low-molecular-weight heparin was administered during the induction chemotherapy without significant resolution of thrombi.
Results : After complete remission with the induction chemotherapy, the patient underwent RV thrombectomy and pulmonary thromboendarterectomy. Pathology of the removed masses confirmed organizing thrombi. The child had no postoperative complication. Postoperative CT and echocardiography revealed no residual thrombus except for the minimal thrombus attached to tricuspid valve.
Conclusion : RV thrombosis and PTE in children with ALL are extremely rare, and to our knowledge, no surgical case has been reported to date. Surgical management of RV thrombosis and PTE in children with ALL is challenging due to the high risk of bleeding and infection. We have successfully performed RV thrombectomy and pulmonary thromboendarterectomy in a child with ALL just after completion of the induction chemotherapy without any postoperative complication.
책임저자: Cheul Lee
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
발표자: Jiyun Lee, E-mail : waspent10c@gmail.com