ABSTRACT
Infected right atrial thrombosis is an uncommon but severe complication of the use
of central indwelling catheters in children. Massive thrombi around a right atrial
catheter were seen in two critically ill premature infants after 3 weeks of parenteral
nutrition. A catheter-related sepsis had previously occurred and had been treated
by antibiotics. Subsequently, protracted thrombocytopenia, fluctuating hepatomegaly,
and increasing respiratory distress were found in both cases. A right atrial mass
was detected by 2 dimensional echocardiography. Cardiotomies for removal of the infected
thrombus were performed with success in both cases. In one infant, weighing only 900
gm, surgical removal was accomplished with the aid of inflow stasis. Premature infants
with catheter-related sepsis appear at greater risk for intracardiac thrombosis and
should undergo echocardiography as part of their evaluation. Infected atrial thrombi
can be safely removed by cardiotomy even in the very small premature infant.
