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Intracardiac thrombosis diagnosed by echocardiography in childhood: predisposing and etiological factors
S Ozkutlu1, N Ozbarlas, S Ozme
1Department of Pediatric Cardiology, Hacettepe University Medical School, Ankara, Turkey.
Insights
Protein-C deficiency is a key cause of intracardiac thrombi in children, even with normal heart anatomy. Investigating this deficiency is crucial for all pediatric intracardiac thrombi cases.
Area of Science:
- Pediatric Cardiology
- Hematology
Background:
- Intracardiac thrombi in children can arise from various factors.
- Identifying the precise etiological cause is critical for effective management.
Purpose of the Study:
- To discuss the etiology and predisposing factors of intracardiac thrombi in pediatric patients.
- To highlight the significance of protein-C deficiency as an etiological factor.
Main Methods:
- Case series analysis of eleven pediatric patients with intracardiac thrombi.
- Evaluation of cardiac anatomy and etiological factors, including protein-C levels.
Main Results:
- Thrombi were found in the left heart (5), right heart (5), or both (1).
- Predisposing factors included dilated cardiomyopathy, mitral valve hypoplasia, and pulmonary valvar stenosis.
- Protein-C deficiency was identified as the cause in three patients with normal cardiac anatomy (one congenital, two acquired due to sepsis).
Conclusions:
- Protein-C deficiency is an important etiological factor in pediatric intracardiac thrombi.
- Investigation for protein-C deficiency is recommended in all pediatric intracardiac thrombi cases, regardless of other identified factors.
Abstract:
Eleven cases of intracardiac thrombi caused by different factors including protein-C deficiency are presented for discussion of the etiology and predisposing factors of intracardiac thrombi during infancy and childhood, and to stress the importance of protein-C deficiency as an etiological factor. Thrombi were localised in the left heart in five patients and right heart in five patients. One patient had both-sided thrombi. Four of our patients had dilated cardiomyopathy, one had mitral valve hypoplasia, and one had pulmonary valvar stenosis as the predisposing factors for thrombus formation. In three patients whose cardiac anatomies were completely normal, we determined protein-C deficiency as an etiological factor of thrombus formation. One of these had congenital protein-C deficiency and the other two had acquired temporary protein-C deficiency due to sepsis. In conclusion we recommend that protein-C deficiency should be investigated as an etiological factor in all cases of intracardiac thrombi irrespective of whether or not another predisposing factor is identified.