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Cardiac findings and long-term thromboembolic outcomes following pulmonary embolism in children: a combined retrospective-prospective inception cohort study

Published online by Cambridge University Press:  22 October 2012

Hayley S. Hancock ,
Michael Wang ,
Katja M. Gist ,
Elizabeth Gibson ,
Shelley D. Miyamoto ,
Peter M. Mourani ,
Marilyn J. Manco-Johnson  and
Neil A. Goldenberg
Hayley S. Hancock*
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Michael Wang
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Katja M. Gist
Affiliation:
Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Elizabeth Gibson
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Shelley D. Miyamoto
Affiliation:
Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Peter M. Mourani
Affiliation:
Division of Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Marilyn J. Manco-Johnson
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
Neil A. Goldenberg
Affiliation:
Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America Department of Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America CPC Clinical Research, Aurora, Colorado, United States of America
*
Correspondence to: Dr H. S. Hancock, MD, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Box 158, Aurora, CO 80045, United States of America. Tel: +1 720 777 6918; Fax: +1 720 777 7258; E-mail: [email protected]
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Abstract

In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children – age less than or equal to 21 years – with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.

Keywords

Heart strainventricular dysfunctioncardiogrampulmonary hypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 344 - 352
Copyright
Copyright © Cambridge University Press 2012 

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