Abstract
Intracardiac thrombosis in patients with a dilated cardiomyopathy can be life threatening. This study investigated the incidence, risk factors, and outcome of intracardiac thrombosis in children with dilated cardiomyopathy. A retrospective review of the clinical records was performed in 83 children with dilated cardiomyopathy diagnosed from January 1995 to December 2008. Intracardiac thrombi were detected in 5 patients (6.0%). The intracardiac thrombi were found mainly in the left ventricle (n = 3). One patient had a thrombus in the left atrium at the time of diagnosis, and a right ventricular thrombus was found in 1 patient with unrepaired ventricular septal defect complicated by pulmonary hypertension. Intracardiac thrombosis developed during rapid deterioration of ventricular function, and all patients had a poor ejection fraction of the left ventricle. All patients were treated with heparinization, and thrombectomy was performed in 1 patient. Three patients achieved complete resolution of the thrombus without further embolic complications. Careful evaluation and aggressive anticoagulation are necessary for the prevention of intracardiac thrombosis in children with poor ventricular function, especially during rapid deterioration of ventricular function.
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Ahnert AM, Freudenberger RS (2008) What do we know about anticoagulation in patients with heart failure? Curr Opin Cardiol 23:228–232
Aspesberro F, Beghetti M, Oberhansli I, Ozsahin H, Humbert J, Rimensberger PC (1999) Local low-dose urokinase treatment of acquired intracardiac thrombi in preterm infants. Eur J Pediatr 158:698–701
Atluru VL, Epstein LG, Gootman N (1985) Childhood stroke and supraventricular tachycardia. Pediatr Neurol 1:54–56
Blondheim DS, Jacobs LE, Kotler MN, Costacurta GA, Parry WR (1991) Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J 122(3 Pt 1):763–771
Chang YC, Wu JM, Wu MH, Wang JK, Lue HC (1995) Left ventricular thrombi in children with dilated cardiomyopathy. J Formos Med Assoc 94:469–473
Dries DL, Rosenberg YD, Waclawiw MA, Domanski MJ (1997) Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. J Am Coll Cardiol 29:1074–1080
Falk RH, Foster E, Coats MH (1992) Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study. Am Heart J 123:136–142
Ferrari F, Vagnarelli F, Gargano G, Roversi MF, Biagioni O, Ranzi A et al (2001) Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator. Arch Dis Child Fetal Neonatal Ed 85:F66–F69
Gottdiener JS, Gay JA, Van Voorhees L, DiBianco R, Fletcher RD (1983) Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography. Am J Cardiol 52:1281–1285
Gunthard J, Stocker F, Bolz D, Jaggi E, Ghisla R, Oberhansli I et al (1997) Dilated cardiomyopathy and thrombo-embolism. Eur J Pediatr 156:3–6
Hays AG, Sacco RL, Rundek T, Sciacca RR, Jin Z, Liu R et al (2006) Left ventricular systolic dysfunction and the risk of ischemic stroke in a multiethnic population. Stroke 37:1715–1719
Herron SB, Lax D, Zamora R (2004) Successful thrombolysis of acute left atrial thrombi in two pediatric patients following interventional cardiac catheterization. J Invasive Cardiol 16:35–39
John JB, Cron SG, Kung GC, Mott AR (2007) Intracardiac thrombi in pediatric patients: presentation profiles and clinical outcomes. Pediatr Cardiol 28:213–220
Kalaria VG, Passannante MR, Shah T, Modi K, Weisse AB (1998) Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy. Am Heart J 135(2 Pt 1):215–220
Koniaris LS, Goldhaber SZ (1998) Anticoagulation in dilated cardiomyopathy. J Am Coll Cardiol 31:745–748
Kumar H (1994) Incidence of intracavitary thrombus in dilated cardiomyopathy. J Assoc Physicians India 42:219–220
Kupferschmid C, Schmaltz AA, Tacke E, Apitz J, Lang D (1984) Left ventricular thrombi in three children with dilated cardiomyopathy: diagnostic procedure and clinical course. Pediatr Cardiol 5:65–69
Loh E, Sutton MS, Wun CC, Rouleau JL, Flaker GC, Gottlieb SS et al (1997) Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 336:251–257
Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D et al (2006) Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113:1807–1816
McCrindle BW, Karamlou T, Wong H, Gangam N, Trivedi KR, Lee KJ et al (2006) Presentation, management and outcomes of thrombosis for children with cardiomyopathy. Can J Cardiol 22:685–690
Ozdemir N, Kaymaz C, Daglar E, Karakaya O, Akcay M, Ozkan M (2002) Severe mitral regurgitation may prevent mural thrombus formation within the left ventricle with systolic dysfunction. Jpn Heart J 43:495–503
Ozkutlu S, Ozbarlas N, Ozme S, Saraclar M, Gogus S, Demircin M (1993) Intracardiac thrombosis diagnosed by echocardiography in childhood: Predisposing and etiological factors. Int J Cardiol 40:251–256
Pac FA, Cagdas DN (2007) Treatment of massive cardiac thrombi in a patient with protein C and protein S deficiency. Blood Coagul Fibrinolysis 18:699–702
Reeder GS, Tajik AJ, Seward JB (1981) Left ventricular mural thrombus: two-dimensional echocardiographic diagnosis. Mayo Clin Proc 56:82–86
Rey C, Piot JD, Bourlon F et al (1984) Two-dimensional echocardiographic diagnosis of an intracardiac thrombus in children. Arch Mal Couer Vaiss 77:503–509
Ricci S (2003) Embolism from the heart in the young patient: a short review. Neurol Sci 24(Suppl 1):S13–S14
Rimensberger PC, Humbert JR, Beghetti M (2001) Management of preterm infants with intracardiac thrombi: use of thrombolytic agents. Paediatr Drugs 3:883–898
Ripley TL, Nutescu E (2009) Anticoagulation in patients with heart failure and normal sinus rhythm. Am J Health Syst Pharm 66:134–141
Sethi KK, Kulshreshtha A, Gupta MP (1984) Recurrent paradoxical embolism in Eisenmenger syndrome. Indian Heart J 36:121–123
Sharratt GP, Lacson AG, Cornel G, Virmani S (1986) Echocardiography of intracardiac filling defects in infants and children. Pediatr Cardiol 7:189–194
Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, Clunie S et al (2006) Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 296:1867–1876
Van Dantzig JM, Delemarre BJ, Bot H, Koster RW, Visser CA (1995) Usefulness of mitral regurgitation in protecting against left ventricular thrombus after acute myocardial infarction. Am J Cardiol 75:1270–1272
Waller BF, Grider L, Rohr TM, McLaughlin T, Taliercio CP, Fetters J (1995) Intracardiac thrombi: frequency, location, etiology, and complications: a morphologic review—Part I. Clin Cardiol 18:477–479
Waller BF, Rohr TM, McLaughlin T, Grider L, Taliercio CP, Fetters J (1995) Intracardiac thrombi: frequency, location, etiology, and complications: a morphologic review—Part II. Clin Cardiol 18:530–534
Yamamoto K, Ikeda U, Furuhashi K, Irokawa M, Nakayama T, Shimada K (1995) The coagulation system is activated in idiopathic cardiomyopathy. J Am Coll Cardiol 25:1634–1640
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This article was presented at the 5th World Congress of Pediatric Cardiology and Cardiac Surgery in Cairns, Australia, June 2009.
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Choi, SH., Jeong, S.I., Yang, JH. et al. A Single-Center Experience with Intracardiac Thrombosis in Children with Dilated Cardiomyopathy. Pediatr Cardiol 31, 264–269 (2010). https://doi.org/10.1007/s00246-009-9602-3
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DOI: https://doi.org/10.1007/s00246-009-9602-3