Echocardiographic assessment of right atrial thrombus related to the implanted port device in patient receiving chemotherapy for non-Hodgkin's lymphoma.

The case of a potentially life-threatening complication related to the use of implanted port device in a 8 year old Non-Hodgkin's Lymphoma patient receiving chemotherapy is described. The device was inserted in early 1997 and used repeatedly for chemotherapy without any complications. In late 1997 during routine screening for cardiac left ventricular function before re-introduction of chemotherapy, an abnormal 1.43 x 1.53 cm mass, consistent with a non-mobile thrombus was found in the right atrium. The initial thrombolytic therapy with recombinant tissue plasmin activator (rt-PA) infused by a central venous catheter was combined with daily echocardiographic examination in order to assess both the timing and mode of thrombus resolution. After 8 days systemic fibrinolytic therapy was discontinued as major hemorrhage from venipuncture sites occurred and the clot dissolution was not obtained. Patient underwent right atriotomy utilizing cardiopulmonary bypass and subsequent surgical thrombus removal was successful. The study evaluated the contribution of two-dimensional echocardiography (2D) in the follow-up of vascuport and other central venous catheter (CVC) location and early diagnosis of related complications such as thrombi. The authors consider that pulmonary flow analyzed with Doppler echocardiography as a reliable, suitable and non-invasive method to evaluate increased pulmonary artery pressure in children with right atrial thrombi and probability of pulmonary microembolism or embolism. As the incidence of right atrial thrombi is highly associated with the catheter tip position in the right atrium, in contrast to their positioning in the superior vena cava or in its junction with the right atrium, the authors recommend that special attention and effort should be given to placing of the catheter tip in the superior vena cava or in its junction with the right atrium avoiding the right atrium during the implantation procedure. The surgical right atrium thrombus removal in patients with no clot dissolution despite systemic thrombolytic treatment underscores the importance of surgical therapy in treating this life-threatening complication of indwelling catheters.

[Right atrial thrombus complicating chemotherapy by central venous catheterization in a child with Hodgkin's disease]. / Zakrzepica prawego przedsionka serca u dziecka jako powiklanie chemioterapii przez cewnik w centralnym ukladzie zylnym.

The atrial catheter (subcutaneous port) was used in a 5 year old boy with Hodgkin's disease for the administration of antineoplastic agents and other drugs. Catheter was flushed daily or every 2 weeks with heparin solution (5 U/ml)). The complications including infection and occlusion were not observed in this patient during observation time. Routine echocardiography performed after eight months of usage of the catheter showed right atrial thrombus. Because of the failure of 14 days fibrinolytic therapy (Actylise) surgical thrombectomy was performed. Bacteriological culture of the surgical specimen was positive for Pseudomonas aeruginosa. The post-operative period passed without complications. Follow-up echocardiography findings were normal. The probable reason of thrombus formation could be damage of the right atrium by stream of drugs or balloting ending of the catheter.

[Central venous catheters with subcutaneous ports for long-term chemotherapy in pediatric oncology]. / Cewniki z podskórnym zbiornikiem zakladane do zyl centralnych w dlugotrwalej chemioterapii w onkologii dzieciecej.

In 29 paediatric oncology patients requiring intravenous chemotherapy, intravenous antibiotics intravenous fluids and blood products transfusions the central venous catheters with subcutaneous ports were inserted. Catheters were left in place for the period lasting from two weeks up to one year in 14 children they still remain in place, 6 catheters were removed due to complications such as occlusion, local necrosis, abscess or bleeding around the place of insertion. The described method, securing long-term venous access, enables safe and painless treatment, which is specially important in paediatric oncology. Moreover, home care can replace hospital treatment and whole procedure is highly cost-effective due to extended time of catheters utilization.