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[2-dimensional echocardiographic diagnosis of an intracardiac thrombus in children]
Insights
Intracardiac thrombi in children, often linked to arrhythmias or cardiomyopathy, can be diagnosed and monitored using two-dimensional echocardiography (2D echo). Prompt anticoagulant therapy can resolve these dangerous blood clots.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Intracardiac thrombi pose a significant risk in pediatric patients.
- Early diagnosis and management are crucial to prevent complications like systemic embolism.
Observation:
- A cooperative study analyzed eight pediatric cases of intracardiac thrombi.
- Cases included thrombi associated with supraventricular arrhythmias, post-surgical complications (transposition of great arteries), and congestive cardiomyopathy.
Findings:
- Two-dimensional echocardiography (2D echo) effectively diagnosed left atrial, right ventricular, and left ventricular thrombi.
- Intraatrial thrombi were linked to supraventricular arrhythmias, while intraventricular thrombi correlated with poor left ventricular contractility.
- Anticoagulant therapy led to the resolution of some thrombi, though one patient experienced hemiplegia.
Implications:
- 2D echo is a valuable tool for diagnosing and monitoring intracardiac thrombi in children.
- Timely diagnosis necessitates prompt anticoagulant or fibrinolytic therapy to prevent embolic events.
- Understanding the association between thrombus location and underlying cardiac conditions aids in risk stratification and treatment planning.
Abstract:
Eight cases of intracardiac thrombi in infants and children were compiled in a cooperative study involving five paediatric cardiological centres. Two babies were hospitalised for cardiac failure due to a severe supraventricular arrhythmia. Two-dimensional echocardiography (2D echo) showed a left atrial thrombus which disappeared after anticoagulant therapy. The third case was unusual: 2D echo performed 4 months after a Senning operation for complete transposition of the great arteries showed stenosis of the pulmonary venous canal and a thrombus above the stenosis: the mass was echogenic, rounded, of variable density and in contact with the pulmonary veins. These findings were confirmed at autopsy. The fourth case was a 34 month old child with Fallot's triad in whom 2D echo showed a right ventricular thrombus, confirmed at surgery. The four remaining cases were thrombi detected in patients with congestive cardiomyopathy. The thrombus was adherent to the left ventricular lateral wall or apex. Two of these thrombi disappeared after anticoagulant therapy, one of which after hemiplegia. 2D echo is a useful tool for the diagnosis and surveillance of intraatrial or intraventricular thrombi. Intraatrial thrombi may be due to supraventricular arrhythmias in children; intraventricular thrombi are usually seen in association with poor left ventricular contractility. The diagnosis of thrombosis should lead to institution of anticoagulant or even fibrinolytic therapy in order to avoid systemic embolism.