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\begin{document}

\title{Perioperative evaluation of neonatal aortic arch thrombosis}



\author[1]{fumiya yoneyama}%
\author[2]{Travis Wilder}%
\author[3]{Michiaki Imamura}%
\affil[1]{Tsukuba Daigaku Fuzoku Byoin}%
\affil[2]{Texas Children's Hospital}%
\affil[3]{Baylor College of Medicine}%


\vspace{-1em}



  
  \date{May 04, 2024}


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\selectlanguage{english}
\begin{abstract}
Herein, we present a neonatal case of coarctation of the aorta, with
aortic arch thrombus confirmed by echocardiography. We performed
thrombus removal and aortic arch repair emergently. This critical
condition necessitates quick preoperative evaluation with
echocardiography. Moreover, postoperative evaluation using computed
tomography is reasonable to assess an aortic arch configuration, and
exclude the remnant thrombus.%
\end{abstract}%



\sloppy


\textbf{Perioperative evaluation of} \textbf{neonatal aortic arch
thrombosis}

Fumiya Yoneyama, M.D., Ph.D., Travis J Wilder, M.D., Michiaki Imamura,
M.D., Ph.D.

Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX

Corresponding author:

Fumiya Yoneyama, M.D., Ph.D. Division of Pediatric Cardiovascular
Surgery, Texas Children Hospital 6651 Main St, Houston, TX 77030 E mail:
fxyoneya@texaschildrens.org

Manuscript Category: Case Image

Running Title: CoA with arterial thrombus

Word count: 515

\textbf{CONFLICT OF INTERESTS} : The authors declare that there are no
conflict of interests.

\textbf{ETHICS STATEMENT} : This manuscript and all of its content meet
the ethical guidelines, including adherence to the legal requirements of
the study country. The need for patient consent was waived.

\textbf{ABSTRACT}

Herein, we present a neonatal case of coarctation of the aorta, with
aortic arch thrombus confirmed by echocardiography. We performed
thrombus removal and aortic arch repair emergently. This critical
condition necessitates quick preoperative evaluation with
echocardiography. Moreover, postoperative evaluation using computed
tomography is reasonable to assess an aortic arch configuration, and
exclude the remnant thrombus.

The patient was a 1-day-old boy (birth weight 3.0 kg) with tachypnea and
cold lower extremities. Echocardiography demonstrated severe coarctation
of the aorta (CoA) and thrombus at the distal arch, and severely
depressed ventricular function (Figure A). We initiated anticoagulation
therapy and immediately sent him to the operation room (OR).

Following median sternotomy, we placed arterial cannulas on the
ascending aorta and main pulmonary artery. Cardiopulmonary bypass was
initiated with bicaval cannulations. At a temperature of 18\selectlanguage{ngerman}°, we
crosslamped the ascending aorta, and injected a cardioplegic solution.
Under circulatory arrest, the distal ascending aorta was longitudinally
opened. Using Forgaty catheter, we removed clots from the
brachiocepharic right carotid and left subclavian artery as well as the
distal aortic arch. We began selective cerebral perfusion after
thrombectomy. The ductus arteriosus and isthmus were ligated, and all
ductal tissues were excised. After clamping the descending aorta, its
anterior surface was longitudinally opened. We reconstructed the aortic
arch using a homograft patch. The patient was extubated on postoperative
day (POD) 5. Computed tomography (CT) on POD 18 displayed a smooth
aortic arch curvature and no intraluminal thrombus (Figure B). She was
discharged on POD 21.

Adequate and timely diagnosis of CoA is crucial for good prognosis,
considering the association between early treatment and lower risks of
long-term morbidity and mortality {[}2{]}. Aortic arch thrombosis in
neonates is rare, however critical with a mortality rate
\textgreater{}50\% {[}1{]}. This necessitates prompt recognition of the
aforementioned condition and careful echocardiographic evaluation of
aortic arch stenosis. Despite other modalities to evaluate the
condition, such as angiography or CT requiring sedation, we should make
a quick diagnosis with echocardiography, and send the patients to the OR
emergently. Postoperatively, CT evaluation is recommended to assess the
aortic arch configuration and residual thrombus.

\textbf{REFERENCES}

\begin{enumerate}
\item
  Wieland I, Jack T, Seidemann K, et al. Neonatal aortic arch
  thrombosis: analysis of thrombophilic risk factors and prognosis.
  Cardiol Young. 2014;24:33-9.
\item
  Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical
  management of aortic coarctation. Heart. 2017;103:1148-1155.
\item
\end{enumerate}

\textbf{Figure Legend}

(A) Preoperative echocardiography, (B) Postoperative computed tomography

AAo = Ascending aorta, DAo = descending aorta

\textbf{Hosted file}

\verb`Figure 06.12.2021.pptx`  available at \url{https://authorea.com/users/422846/articles/528468-perioperative-evaluation-of-neonatal-aortic-arch-thrombosis}

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