Cardiology in the Young

Original Articles

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

Hayley S. Hancocka1 c1, Michael Wanga2a3, Katja M. Gista4, Elizabeth Gibsona2a3, Shelley D. Miyamotoa4, Peter M. Mourania5, Marilyn J. Manco-Johnsona2a3 and Neil A. Goldenberga2a3a6a7

a1 Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a2 Sections of Hematology/Oncology/Bone Marrow Transplantation, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a3 Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a4 Division of Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a5 Division of Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a6 Department of Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America

a7 CPC Clinical Research, Aurora, Colorado, United States of America

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.

(Received November 20 2011)

(Accepted June 24 2012)

(Online publication October 22 2012)

Keywords

  • Heart strain;
  • ventricular dysfunction;
  • cardiogram;
  • pulmonary hypertension

Correspondence

c1 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: hancockh@med.umich.edu

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