Successful thrombolysis of acute left atrial thrombi in two pediatric patients following interventional cardiac catheterization.

Acute left atrial intracardiac thrombi require aggressive therapy due to the risk of embolization and cerebrovascular accidents. Current treatment includes the use of high-dose recombinant tissue plasminogen activator (rTPA), which is associated with significant bleeding complications. We report the successful treatment of two pediatric patients with acute left atrial thrombi following interventional cardiac catheterizations using low-dose rTPA. Echocardiography was used to document the presence of the thrombi and monitor treatment with rTPA infusion at 0.03 mg/kg/hour and heparin. Both patients experienced complete resolution of left atrial thrombi without hemodynamically significant side effects. Low-dose (0.03 mg/kg/hour) rTPA with heparin is an acceptable and safe alternative to high-dose rTPA infusion for intracardiac thrombi in children.