Extracorporeal Membrane Oxygenation-Supported Aspiration Thrombectomy and Catheter-Directed Thrombolysis for Massive Pulmonary Artery and Inferior Vena Cava Thrombosis in a Neonate.

Massive pulmonary artery thrombosis in neonates is rare and frequently fatal when associated with right ventricular failure and hemodynamic collapse. We report a premature neonate with extensive inferior vena cava, right ventricular outflow tract, and bilateral pulmonary artery thrombosis resulting in respiratory failure requiring venoarterial extracorporeal membrane oxygenation. Progressive thrombus burden despite systemic anticoagulation prompted catheter-directed mechanical aspiration thrombectomy using escalating aspiration systems with adjunctive localized thrombolysis. Significant resolution of the thrombus was achieved with restoration of pulmonary blood flow and improvement in right ventricular function. This case demonstrates the feasibility of ECMO-supported aspiration thrombectomy as a life-saving strategy for neonatal thromboembolic disease.