Z Geburtshilfe Neonatol 2023; 227(03): e53
DOI: 10.1055/s-0043-1769278
Abstracts
Freie Vorträge
Postersession 02 – Herz / Kreislauf

A rare case of left atrial thrombus mimicking cardiac tumor in a female neonate

Kathrin Pollmann
1   Heidelberg University Children’s Hospital, Department of Neonatology, Heidelberg, Germany
,
Debora Call
1   Heidelberg University Children’s Hospital, Department of Neonatology, Heidelberg, Germany
,
Tina Heinzmann
1   Heidelberg University Children’s Hospital, Department of Neonatology, Heidelberg, Germany
,
Alexander Kovacevic
2   Heidelberg University Children’s Hospital, Department of Pediatric and Congenital Cardiology, Heidelberg, Germany
,
Raoul Arnold
2   Heidelberg University Children’s Hospital, Department of Pediatric and Congenital Cardiology, Heidelberg, Germany
,
Christian Gille
1   Heidelberg University Children’s Hospital, Department of Neonatology, Heidelberg, Germany
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Background Left atrial thrombus in the neonatal period is a rarity. Most commonly, atrial thrombosis occurs in infants in association with congenital heart disease or as a complication of a central venous catheter. The purpose of this clinical case report is to highlight the unusual postnatal event of left atrial thrombosis after supraventricular tachycardia (SVT) in a full-term neonate.

Case Presentation A female newborn without known risk factors was noticed with tachyarrhythmia on the first postnatal day. Neither a murmur nor typical clinical signs of cardiac failure were present. Following transport to the neonatal intensive care unit, electrocardiogram revealed a regular narrow complex tachycardia with a heart rate of ~250 beats per minute. Atrial flutter (AFL) with intraatrial reentry and 1:1 conduction unmasked when adenosine was administered. Electric cardioversion on the first day of life was successfully performed to restore sinus rhythm. Subsequent transthoracic echocardiography detected a hyperechoic, inhomogeneous mass (1cm x 1cm) located in the left atrium close to the mitral valve. Impairment in left ventricular function was recorded only temporary after AFL. Benign and malignant neonatal cardiac tumors and thrombotic events were included in the differential diagnosis. Additional investigations, comprising hypercoagulability work-up, genetic analysis and diagnostics of tuberous sclerosis, which is associated with rhabdomyoma, were unremarkable. Based on clinical findings and echocardiographic features, a thrombus caused by atrial flatter was urgently suspected. Antithrombotic and antiarrhythmic therapy with heparin and propranolol was initiated. Follow-up echocardiography showed mass regression already during the inpatient stay, further supporting the tentative diagnosis.

Conclusion SVT is the most common sustained arrhythmia in neonates. However, the risk of atrial thrombus formation, in particular due to atrial flutter, is relatively low. The left atrial thrombus found in our case could be due to atrial stand-still secondary to AFL. Electrical and mechanical dysfunction during atrial stand-still leads to hypocirculation and blood stasis, favouring atrial thrombus formation. In summary, this case report underscores the importance of early identification, comprehensive diagnostic clarification and the need for timely therapy to prevent potential life-threatening complications in infants with structurally normal hearts. Heparin may be a well-tolerated and effective therapeutic approach for resolution of atrial thrombi in neonates.



Publication History

Article published online:
06 June 2023

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