Catheter-Related Intracardiac Thrombosis in Children: A 10-Year Single-Center Retrospective Study.

OBJECTIVES: Central venous catheter-related intracardiac thrombosis is a rare but potentially life-threatening complication in pediatric patients. MATERIALS AND METHODS: This retrospective single-center study included pediatric patients diagnosed with catheter-related intracardiac thrombosis. Demographic characteristics, thrombus features, inflammatory markers, microbiological findings, treatment strategies, and outcomes were analyzed. RESULTS: Twenty-two patients were included. Median age was 143 months (range 2-217). Median CRP level was 11.8 mg/L (0.2-190). Underlying disease was predominantly renal (36.4%) and malignancy (27.3%). Catheters were interjugular venous catheterization (54.5%), tunneled cuffed hemodialysis catheter (27.3%), and totally implantable venous access port (18.2%). Echocardiography was most commonly triggered by infection-related presentations (40.9%) or performed during routine/high-risk surveillance (31.8%). Median thrombus size was 10.5 mm (range 2-35). Right atrial thrombi were present in 20/22 patients (90.9%); one patient had right atrial plus right ventricular thrombi, and one had left ventricular thrombi secondary to myocarditis. Thrombus resolution occurred in 21/22 catheter-related right atrial cases (100% of right-sided thrombi). tPA was used in 45.5%; catheter removal in 40.9%; and surgical thrombectomy in 13.6%. Thrombus resolution occurred in 21/22 (95.5%); one patient with myocarditis and severe heart failure died. Median time to resolution was 8 days (range 1-51). Blood cultures were positive in 40.9% (most commonly coagulase-negative staphylococci). In this small cohort, time to thrombus resolution was similar between patients receiving tPA plus low-molecular-weight heparin and those managed with low-molecular-weight heparin alone, despite larger baseline thrombus size in the tPA group. CONCLUSION: Catheter-associated intracardiac thrombosis is clinically important complication in children with chronic diseases requiring central venous access. Our findings suggest that intracardiac thrombosis may develop silently in patients with long-term central venous catheters, supporting consideration of routine echocardiographic screening in high-risk subgroups. However, the optimal screening interval and target populations remain to be defined by prospective studies. While a size- and status-guided treatment strategy achieved high resolution rates, prevention should be prioritized.