title: Cardiac findings and long-term thromboembolic outcomes following pulmonary embolism in children: a combined retrospective-prospective inception cohort study.
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.
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado 80045, USA. hancockh@med.umich.edu
authors.forename: Hayley S
authors.initials: HS
authors.lastname: Hancock
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Katja M
authors.initials: KM
authors.lastname: Gist
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gibson
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mourani
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Manco-Johnson
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D003952:Diagnostic Imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants