ABSTRACT
We report three cases of intracardiac thrombi in preterm infants of very low birth weight, in whom local low-dose urokinase treatment achieved complete thrombolysis without any signs of systemic fibrinolytic activity or side-effects. This new treatment strategy seems to be safe, requires minimal monitoring of fibrinolytic activity, and may be a new option for thrombolysis in high-risk patients such as premature infants, patients recently operated on, and patients presenting with other contra-indications for systemic fibrinolytic therapy.
Subject(s)
Heart Diseases/drug therapy , Infant, Premature, Diseases/drug therapy , Plasminogen Activators/administration & dosage , Thrombosis/drug therapy , Urokinase-Type Plasminogen Activator/administration & dosage , Female , Heart Atria/diagnostic imaging , Humans , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Male , Plasminogen Activators/therapeutic use , Risk Factors , Thrombolytic Therapy/methods , Treatment Outcome , Ultrasonography , Urokinase-Type Plasminogen Activator/therapeutic useABSTRACT
UNLABELLED: All cases of infective endocarditis occurring from January 1990 to December 1996 at our institution were reviewed, with a special focus on fungal endocarditis. Five critically ill children with fungal endocarditis and eleven children with bacterial endocarditis were recorded. The proportion of fungal endocarditis in our series was 5/16 (31%) and Candida albicans (4/5) was the most common fungal pathogen. Only one patient required heart surgery because of a loose patch but all the others were treated only by medical management for cure. The hospital survival rate was 80% (4/5) and the overall long-term survival rate was 60% (3/5) with only one death directly related to fungal infection. CONCLUSION: Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment.