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Right heart thrombus in infants and children
K Kádár1, I Hartyánszky, L Király
1Semmelweis University Medical School, Pediatric Department, Heim Pál Hospital, Budapest, Hungary.
Insights
This study details right heart thrombus (RHT) in 10 children, highlighting echocardiographic findings and management strategies. Early diagnosis and treatment, including anticoagulants or surgery, improved survival rates in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Cardiovascular Surgery
Background:
- Right heart thrombus (RHT) is a rare but serious condition in children.
- Echocardiography is crucial for diagnosing RHT in pediatric patients.
- RHT can occur in children with and without structural heart disease.
Purpose of the Study:
- To present the echocardiographic features of right heart thrombus (RHT) in pediatric patients.
- To describe the management strategies employed for RHT in children.
- To evaluate the outcomes of RHT management in this cohort.
Main Methods:
- Retrospective review of 10 pediatric cases with RHT diagnosed via echocardiography.
- Echocardiographic assessment of thrombus location and associated cardiac anomalies.
- Analysis of treatment modalities including anticoagulation, antiplatelet agents, and surgical intervention.
Main Results:
- RHT was detected in various locations including the right atrium, right ventricle, and vena cava.
- Structural heart disease, such as transposition of great arteries (TGA) and tricuspid atresia, was present in seven patients.
- In patients with normal hearts, RHT was linked to shunt systems or occurred without a clear predisposing factor.
- Seven out of ten patients survived and were followed up with echocardiography.
Conclusions:
- Echocardiography is effective in diagnosing RHT in children.
- Management of RHT in pediatric patients involves anticoagulation, antiplatelet therapy, or surgery.
- Prompt diagnosis and appropriate management contribute to favorable outcomes in children with RHT.
Abstract:
The echocardiographic features and management of 10 children with right heart thrombus (RHT) are presented. The patients' ages ranged from 2 weeks to 12 years. Three patients were less than 3 weeks old. The echocardiographic diagnosis was confirmed in five patients by surgery or autopsy. The thrombus was detected in the right atrium (five patients), in the right ventricle (three), on the tricuspid valve or within the inferior vena cava, the superior vena cava, or its extension following Senning's operation for transposition of great arteries (TGA). Seven patients had structural heart disease: TGA in four, tricuspid atresia in three. In two of three patients with anatomically normal heart, the thrombus occurred as a complication of a ventriculoatrial and a lymphovenous shunt system. The third patient had no predisposing factor. Five patients were treated with anticoagulants or platelet anti-aggregating agents and four by surgery. Seven patients survived and were followed by echocardiography.