Percutaneous Treatment of Acute Thromboembolic Occlusion of the Superior Mesenteric Artery in Neonate

Objectives: Acute mesenteric ischemia (AMI) is a serious event that usually affects the elderly and is associated with a high mortality rate. AMI is a rare condition in neonatology and pediatrics.

Methods: A 2-day-old female neonate (2,310 g, Apgar's score: 9/10/10) with suspect of congenital heart disease was referred to our department. The patient was intubated, a therapy with antibiotic agents was started due to progressive worsening of the patient condition. Echocardiogram showed a severe mitral and tricuspid valve regurgitation without structural heart disease, thickened mitral valve with conspicuous structure (suspected as thrombus), and the ventricular function was reduced. Anticoagulation with heparin was started. After starting an anticongestive therapy with levosimendan, milrinone, and diuretic agents, the patient's condition was ameliorated. The patient was extubated after 4 days. The anticongestive therapy was switched to oral (β-blocker, ACE-inhibitor, and spironolacton). Echocardiography control keeps showing the suspected thrombus on the anterior leaflet of the MV but no significant regurgitation, ventricular function switched to normal. At day 16, the patient condition becomes worse, the patient tolerates no more feeding and the stool was bloody. Echocardiogram reveals a good ventricular function without significant MR, but the suspected mitral valve thrombus was not shown. Abdominal ultrasound revealed a thromboembolic occlusion of the superior mesenteric artery (SMA). The patient was transferred to the cath laboratory. The performed aortogram revealed a thrombotic occlusion of the origin of the superior mesenteric artery with minimal residual perfusion of the SMA retrograde through collaterals arteries. After introducing of a 0.014″ wire in the SMA, balloon angioplasty was successfully performed (1.2 and 2 mm). A control angiogram in SMA showed a very good result. The patient condition was ameliorated, stool was no bloodier, and we started feeding the patient again without problem. The heparin infusion was maintained. Abdomen ultrasound controls showed a good result in the recanalized SMA with mild accelerated flow (2 m/s) in the Doppler signal. The patient was discharged at the age of 7 weeks with low molecular weight heparin. In the follow-up, 2.5 months after the catheter procedure, the patient was in well condition, with good growth (weight, 3,600 g), and the abdomen ultrasound revealed a good perfusion of the SMA without stenosis.

Conclusion: Percutaneous treatment with balloon angioplasty in neonates with timely diagnosed AMI is safe and feasible and reduce the risk of complications and mortality after AMI.

Publication History

Article published online:
21 February 2021