Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis
DOI:
https://doi.org/10.1532/hsf.1378Abstract
The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.References
AÅŸilioÄŸlu N, Paksu MS, Sungur M, Demirel S. 2012. Intracardiac thrombus case caused by blunt trauma due to child abuse. Pediatr Emerg Care 28:566-7.
Beregi JP, Aumégeat V, Loubeyre C, Coullet JM, Asseman P, Debacker-Steckelorom C. 1997. Right atrial thrombi: percutaneous mechanical thrombectomy. Cardiovasc Intervent Radiol 20:142-5.
Cetin Iİ, Ekici F, Ünal S, Kocabaş A, Sahin S, Yazıcı MU. 2014. Intracardiac thrombus in children: the fine equilibrium between the risk and the benefit. Pediatr Hematol Oncol 31:481-7.
de Winkel N, Becker K, Vogt M. 2010. Echogenic mass in the right atrium after surgical ventricular septal defect closure: thrombus or tumour? Cardiol Young 20:86-8.
Ekici F, Varan B, Şaylan-Çevik B, Özkan M, Ok-Atılgan A, Oktay A. 2011. A large intracardiac fungus ball in a premature infant. Turk J Pediatr 53:325-7.
Gerede DM, Ongun A, Durdu S, Acibuca A, Dincer I. 2015. A rare myxoma in the right ventricular outflow tract. Turk Gogus Kalp Dama, 23:739-40.
Kovacikova L, Skrak P, Zahorec M. 2011. Thrombus obstructing the right ventricle outflow tract in a neonate with methylenetetrahydrofolate reductase 677TT genotype. Eur J Pediatr 170:1201-3.
Michta K, Pietrzyk E, Wożakowska-KapÅ‚on B. 2015. Surgically treated cardiac masses — a single-centre experience Folia Cardiologica 10:86-90.
Ozimek W, Wróblewska-KaÅ‚uzewska M, Gadomski A, SopyÅ‚o B, Rokicka-Milewska R, Jaranowska D. 2000. Echocardiographic assessment of right atrial thrombus related to the implanted port device in patient receiving chemotherapy for non-Hodgkin’s lymphoma. Med Sci Monit 6:1013-17.
Shah CP1, Thakur RK, Ip JH, Xie B, Guiraudon GM. 1996. Management of mobile right atrial thrombi: a therapeutic dilemma. J Card Surg 11:428-31.
Shin JH, Kim GN, Kil HR, Chang MY. 2013. Successful use of low molecular weight heparin in intracardiac thrombus of an extremely low birth weight infant. Indian J Pediatr 80:779-80.
Tas S, Tuncer E, Boyacioglu K, et al. 2014. Cardiac myxomas: a 27-year surgical experience. Turk Gogus Kalp Dama 22:526-33.
Yamamoto N, Hisamochi K, Sugiyama S, Nakayama Y, Senoo Y, Teramoto S. 1993. Extirpation of intra-atrial tumor thrombus of renal cell carcinoma by means of extracorporeal circulation-report of a case. Nihon Kyobu Geka Gakkai Zasshi 41:492-7.
