THROMBOLYSIS OF MODIFIED BLALOCK-TAUSSIG- SHUNTS IN INFANCY WITH RECOMBINANT PLASMINOGEN-ACTIVATOR

Since 1983, when c-DNA was isolated, recombinant tissue plasminogen ac tivator (rtPA), an endothelial-cell-produced activator of fibrinolysis is used, more increasingly often in therapy of thrombosis. Whereas so me studys have been published regarding efficacy and safety of rtPA in different thrombotic states of adults, only case reports exist in chi ldren. Doses vary widely (0.8-6 mg/kg/d), bleeding complications are r eported in up to 50%. We report on four infants with complex cyanotic congenital heart disease who developed an early postoperative thrombos is of a modified Blalock-Taussig shunt. By local low dosage applicatio n of rtPA we could achieve a complete lysis of the thrombus in three o f our four patients. In one patient we were unsuccessful due to a dist al stenosis of the shunt. This infant required repeat surgery with cre ation of a central aortopulmonary shunt. We saw severe bleeding in one , requiring transfusion of packed cells, and formation of a perigraft reaction in another patient. In our experience local application of rt PA in low doses is a good therapeutical option in patients with thromb osis of aorto-pulmonary shunts, especially in the first postoperative days.