Thrombophilia, left ventricular dysfunction and intracardiac thrombi in children

Area of Science:

• Pediatric Cardiology
• Hematology
• Critical Care Medicine

Background:

• Intracardiac thrombi (ICT) are rare in children, but incidence is rising.
• Left ventricular dysfunction and hypercoagulable states are potential contributors to ICT formation.
• This study investigates ICT incidence and risk factors in pediatric cardiac failure.

Purpose of the Study:

• To determine the incidence of intracardiac thrombi (ICT) in children with cardiac failure and left ventricular dysfunction.
• To identify risk factors for developing ICT upon admission in this pediatric population.
• To highlight the association between hypercoagulable states and ICT in pediatric cardiac failure.

Main Methods:

• Retrospective chart review of pediatric patients (up to 18 years) admitted to the Pediatric Intensive Care Unit.
• Inclusion criteria: cardiac failure with left ventricular dysfunction between 2003-2008.
• Data collection focused on clinical signs, echocardiographic findings, and history of hypercoagulable states.

Main Results:

• Twenty-one patients were included, with dilated cardiomyopathy in 52% and myocarditis in others.
• A history of hypercoagulable states was present in 90% of patients.
• Patients with a hypercoagulable state had a significantly higher incidence of ICT (3/7) compared to those without (0/12, p=0.043).
• Two patients with ICT experienced embolic events.

Conclusions:

• Cardiac failure with left ventricular dysfunction increases ICT risk, especially with coexisting hypercoagulable states.
• Hypercoagulable states are a significant risk factor for ICT and thromboembolism in pediatric cardiac failure.
• Thorough evaluation for hypercoagulability on admission is essential for managing these high-risk pediatric patients.