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Case Reports in Pediatrics
Volume 2012 (2012), Article ID 193093, 4 pages
http://dx.doi.org/10.1155/2012/193093
Case Report

Successful Treatment of Acute Lymphoblastic Leukemia in a Child with Trisomy 21 and Complex Congenital Heart Disease with Mechanical Prosthetic Valve

1Division of Pediatric Oncology, Hematology and BMT, Department of Pediatrics, British Columbia’s Children’s Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4
2Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
3Division of Pediatric Interventional Radiology, Children’s and Women’s Health Center of British Columbia, University of British Columbia, Vancouver, BC, Canada V6H 3V4
4Division of Pediatric Cardiology, Department of Pediatrics, British Columbia’s Children’s Hospital, University of British Columbia, Vancouver, BC, Canada V6H 3V4

Received 29 June 2012; Accepted 28 July 2012

Academic Editors: E. De Vries and H. Horigome

Copyright © 2012 Saima Alvi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 10-year-old girl with trisomy 21 and complex congenital heart disease presented with acute lymphoblastic leukemia. Her chemotherapy required modifications due to poor baseline cardiac status and a mechanical prosthetic heart valve that was dependent on anticoagulation. We describe our management including the use of low-molecular-weight heparin as anticoagulation for a mechanical heart valve, the safe delivery of intrathecal chemotherapy included bridging with unfractionated heparin, and the use of fluoroscopic guidance to minimize the risk of bleeding. Adjustments were made to avoid anthracyclines. The child tolerated therapy well without complications and remains relapse free five years after diagnosis.