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

  • Hayley S. Hancock (a1), Michael Wang (a2) (a3), Katja M. Gist (a4), Elizabeth Gibson (a2) (a3), Shelley D. Miyamoto (a4), Peter M. Mourani (a5), Marilyn J. Manco-Johnson (a2) (a3) and Neil A. Goldenberg (a2) (a3) (a6) (a7)...

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.

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Corresponding author

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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Keywords

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

  • Hayley S. Hancock (a1), Michael Wang (a2) (a3), Katja M. Gist (a4), Elizabeth Gibson (a2) (a3), Shelley D. Miyamoto (a4), Peter M. Mourani (a5), Marilyn J. Manco-Johnson (a2) (a3) and Neil A. Goldenberg (a2) (a3) (a6) (a7)...

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