RESUMEN
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.
Asunto(s)
Cardiopatías/tratamiento farmacológico , Enfermedades del Prematuro/tratamiento farmacológico , Activadores Plasminogénicos/administración & dosificación , Trombosis/tratamiento farmacológico , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Masculino , Activadores Plasminogénicos/uso terapéutico , Factores de Riesgo , Terapia Trombolítica/métodos , Resultado del Tratamiento , Ultrasonografía , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoRESUMEN
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.