118 NON-INVASIVE EVALUATION OF SUPERIOR VENA CAVA (SVC) AND RIGHT ARTERIAL (RA) THROMBOSIS COMPLICATING CENTRAL HYPERALIMENTATION (CHA) IN PREMATURE INFANTS

Abstract

Within the last 6 mos., we have encountered 3 infants who presented with signs of SVC obstruction complicating CHA. Signs occurred a mean of 30 days after placement of the central line (range 21-42 days) and included deterioration of pulmonary status with pleural effusions and edema of the upper trunk. In each case 2-D echocardiography (2DE) at a frequency of 5 mHz revealed a large, mobile echodense mass in the RA, with extension through the tricuspid valve into the right ventricular outflow tract. Two infants had the diagnosis confirmed by angiography and were treated with intravenous heparin for 10 days. The other infant did not receive heparin. Serial 2DE in the treated infants showed a decrease in size of the RA thrombosis in one and complete resolution in the other. Contrast echocardiography in one of the treated infants demonstrated patency of the inferior vena cava while the SVC appeared totally occluded. These findings were confirmed at autopsy. In the untreated patient the RA thrombosis remained stable in size and was operatively removed at age 6 mos. This series indicates that 2DE is a helpful non-invasive means of diagnosing SVC and RA thrombosis complicating CHA when the clinical signs suggest its presence. Further, serial 2DE is helpful in evaluating the status of the RA thrombosis during heparin therapy and in aiding the decision concerning operative removal.

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