Systemic thrombolysis for an intracardiac thrombus in a premature child with a severe diaphragmatic hernia

Intracardiac thrombus is a rare but difficult-to-treat complication in premature infants, with limited therapeutic options. If an urgent neonatal surgical procedure is needed, rescue systemic thrombolysis may be considered as an option to hasten thrombus resolution. In the present case, we illustrate the successful lysis of a right ventricle intracardiac thrombus in a premature child prior to a neonatal emergent surgery for a severe congenital diaphragmatic hernia. The 1-day-old premature child with right-sided diaphragmatic hernia contracted preoperatively a right ventricle thrombus in the context of an early-onset septic shock. Systemic low-dose thrombolysis with urokinase (2000 then 3000 U/kg/h) was infused for 6 days with resolution of the thrombus and no immediate or delayed intracranial or postcongenital diaphragmatic hernia hemorrhagic complication, performed 72 h after thrombolysis cessation. Low-dose thrombolysis should be discussed if rapid thrombus resolution is required in case of intracardiac thrombus without thrombectomy option.