1
|
Agrawal A, Bajaj S, Bhagat U, Chandna S, Arockiam AD, Chan N, Haroun E, Gupta R, Badwan O, Shekhar S, Kathavarayan Ramu S, Nayar D, Jaber W, Griffin BP, Wang TKM. Intracardiac Thrombus in COVID-19 Inpatients: A Nationwide Study of Incidence, Predictors, and Outcomes. Angiology 2024:33197231225282. [PMID: 38173053 DOI: 10.1177/00033197231225282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
COronaVIrus Disease-2019 (COVID-19) is associated with a hypercoagulable state. Intracardiac thrombosis is a potentially serious complication but has seldom been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. In 2020, COVID-19 inpatients were identified from the National Inpatient Sample (NIS) database. Data on clinical characteristics, intracardiac thrombosis, and adverse outcomes were collected. Multivariable logistic regression was used to identify factors associated with intracardiac thrombosis, in-hospital mortality, and morbidities. In 2020, 1,683,785 COVID-19 inpatients (mean age 63.8 years, 32.2% females) were studied. Intracardiac thrombosis occurred in 0.10% (1830) of cases. In-hospital outcomes included 13.2% all-cause mortality, 3.5% cardiovascular mortality, 2.6% cardiac arrest, 4.4% acute coronary syndrome (ACS), 16.1% heart failure, 1.3% stroke, and 28.3% acute kidney injury (AKI). Key factors for intracardiac thrombosis were congestive heart failure history and coagulopathy. Intracardiac thrombosis independently linked to higher risks of all-cause mortality (odds ratio [OR]: 3.32 (2.42-4.54)), cardiovascular mortality (OR: 2.95 (1.96-4.44)), cardiac arrest (OR: 2.04 (1.22-3.43)), ACS (OR: 1.62 (1.17-2.22)), stroke (OR: 3.10 (2.11-4.56)), and AKI (OR: 2.13 (1.68-2.69)), but not heart failure. While rare, intracardiac thrombosis in COVID-19 patients independently raised in-hospital mortality and morbidity risks.
Collapse
Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Umesh Bhagat
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sanya Chandna
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas Chan
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elio Haroun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Osamah Badwan
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivabalan Kathavarayan Ramu
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Divya Nayar
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wael Jaber
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
2
|
Yoshida T, Uemura A, Tanaka R, Farag A, Mandour AS, Hamabe L, Matsumoto K. Secondary right atrial thrombosis in three dogs: Antithrombotics therapy and echocardiographic follow-up. Vet Med Sci 2023; 9:1973-1979. [PMID: 37491011 PMCID: PMC10508537 DOI: 10.1002/vms3.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/09/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
Three dogs were diagnosed with right atrial thrombosis, thought to be secondary to systemic diseases. Specifically, two cases had hyperadrenocorticism and one case was diagnosed with pancreatitis with acute renal injury. In all cases, the thrombi were found within the right atrium, necessitating a differentiation from cardiac neoplasia. In all three cases, the structures assumed to be thrombi had irregular margins with interspersed hypoechoic regions, which were later confirmed as thrombi based on the responsiveness to therapy. All three cases were prescribed with the combination of clopidogrel and rivaroxaban.The thrombi gradually disappeared after initiation of the combination therapy. Complete resolution of right atrial thrombosis was noted in each dog treated with clopidogrel and rivaroxaban. This combination therapy appears to be safe and well tolerated. Diligent observation of the echocardiographic findings and clinical course allows the diagnosis of thrombosis.
Collapse
Affiliation(s)
- Tomohiko Yoshida
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
| | - Akiko Uemura
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
| | - Ryou Tanaka
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
| | - Ahmed Farag
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
- Faculty of Veterinary Medicine, Department of SurgeryAnesthesiology, and Radiology, Zagazig UniversityZagazigEgypt
| | - Ahmed S. Mandour
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
- Faculty of Veterinary Medicine, Department of Animal Medicine (Internal Medicine)Suez Canal UniversityIsmailiaEgypt
| | - Lina Hamabe
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
| | - Kotaro Matsumoto
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
| |
Collapse
|
3
|
Case SJ, Moon RJ, Bharucha T, Davies JH. Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis. J Pediatr Endocrinol Metab 2023; 36:327-330. [PMID: 36427218 DOI: 10.1515/jpem-2022-0475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bisphosphonates are used in childhood osteoporosis but can cause an acute phase reaction (APR) and hypocalcemia. We present a child with cardiac thrombosis following zoledronate, a previously unreported complication. CASE PRESENTATION An 11-year-old with Duchenne muscular dystrophy and steroid-induced osteoporosis presented 48 h after first zoledronate infusion with fever, tachycardia, tachypnoea and hypoglycaemia. This was managed as acute adrenal crisis and possible sepsis. He also had hypocalcemia, hypophosphatemia, hyponatraemia and hypokalaemia. Echocardiography performed due to persistent chest pain and tachycardia revealed a left ventricular thrombus. CONCLUSIONS Potential causes for intracardiac thrombosis in this patient include ventricular dysfunction due to acute adrenal crisis or electrolyte disturbance, and hypercoagulability due to the APR. Echocardiography should be considered in children with acute cardiovascular compromise following zoledronate. Stress-dose steroids to cover the APR and a reduced starting dose of zoledronate might have reduced the risk of this complication.
Collapse
Affiliation(s)
- Samantha J Case
- Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rebecca J Moon
- Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Tara Bharucha
- Paediatric Cardiology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
4
|
Smaali J, Charef A, Bamous M, Fatihi J, Amezian T. Anasarca Revealing Severe Cardiac Involvement Due to Behçet's Disease (BD): A Case Report. Cureus 2023; 15:e34532. [PMID: 36879693 PMCID: PMC9984977 DOI: 10.7759/cureus.34532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Behçet's disease (BD) is a systemic vasculitis which is most often manifested by recurrent oral aphthosis, genital aphthosis, and ocular involvement with sometimes visceral damage, in particular neurological, digestive, vascular, or renal. We report the case of a 21-year-old man admitted for anasarca who revealed severe cardiac involvement associating endomyocardial fibrosis, intracardiac thrombi and involvement of the tricuspid valve in the context of BD diagnosed a posteriori. Cardiac involvement is exceptional during BD, especially as a mode of entry into the disease. It can be particularly severe, hence the need for early diagnosis, rapid and sometimes aggressive management. Close monitoring is also necessary in order to watch for the occurrence of visceral manifestations, particularly in young patients.
Collapse
Affiliation(s)
- Jihane Smaali
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR.,Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, MAR
| | - Amal Charef
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Mehdi Bamous
- Cardiac Surgery, Mohammed V Military Training Hospital, Rabat, MAR
| | - Jamal Fatihi
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Taoufik Amezian
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| |
Collapse
|
5
|
Akbay Ş, Ekici F, Çomak E. A rare complication of Behçet's disease in a 12-year-old girl: a large intracardiac thrombosis. Cardiol Young 2022; 33:1-3. [PMID: 36377415 DOI: 10.1017/s1047951122003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behcet's disease is a multi-systemic inflammatory disease with a clinical spectrum as a triple complex of recurrent oral, genital ulcers, and uveitis. Cardiac involvement in patients with Behcet's disease is extremely rare and often associated with poor prognosis. Behcet's disease should be considered in the differential diagnosis of right ventricular mass especially in young adults, even there is no typical clinical features of Behcet's disease. In this case, a 12-year-old girl who admitted with chest pain and haemoptysis and then was diagnosed with intracardiac thrombus related to Behcet's disease during follow-up was described.
Collapse
Affiliation(s)
- Şenay Akbay
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Filiz Ekici
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Elif Çomak
- Pediatric Rheumatology, Akdeniz University Medical School, Antalya, Turkey
| |
Collapse
|
6
|
Ramjas V, Jain A, Lee RDM, Fioni F, Tawfik N, Sandhu O, Hamid P. Unraveling the Association Between Myocardial Infarction of Nonobstructive Coronary Arteries and Antiphospholipid Syndrome. Cureus 2021; 13:e17002. [PMID: 34540404 PMCID: PMC8423341 DOI: 10.7759/cureus.17002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
The term "myocardial infarction with nonobstructive coronary arteries (MINOCA)" refers to a condition characterized by clinical signs and symptoms consistent with acute myocardial infarction (AMI) (as defined by the third universal definition of infarction) and coronary arteries that are angiographically normal or nearly normal. A prominent source of morbidity and mortality in patients with antiphospholipid syndrome (APS) is thrombotic events. To evaluate whether there is a relation between APS and MINOCA in this research, we did an extensive assessment of the existing research in this field. According to the data, APS was associated with microvascular thrombosis, aberrant lipid metabolism, hypertension, and abnormalities of the coagulation cascade, among other conditions. Based on the available data, we discovered evidence that suggests a relationship between MINOCA and APS patients. It is vital to raise awareness of this concern among the general public. Also required is the development and implementation of diagnostic and targeted treatment guidelines for patients with APS and MINOCA.
Collapse
Affiliation(s)
- Vishal Ramjas
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arpit Jain
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rholter Dave M Lee
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fioni Fioni
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nouran Tawfik
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Osama Sandhu
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
7
|
Qin X, Liang W, Wu Z. A rare case of cardiac mass complicated with chronic thromboembolic pulmonary hypertension. J Card Surg 2020; 35:3567-3568. [PMID: 32939862 DOI: 10.1111/jocs.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaoli Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
8
|
Bendahmash A, Almanie S, Alwadai A. Intracardiac thrombus formation and thromboembolic events in children with cardiomyopathies: A single-center case series. Clin Case Rep 2020; 8:1693-1697. [PMID: 32983479 PMCID: PMC7495816 DOI: 10.1002/ccr3.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 11/12/2022] Open
Abstract
Intracardiac thrombosis and distant thromboembolic events are rare complications of patients diagnosed with any type of cardiomyopathies. The low prevalence of this entity makes it challenging and unfortunate for the patients and their families. This review aims to add to the current limited available data describing similar clinical entities.
Collapse
Affiliation(s)
- Abdulrahman Bendahmash
- Department of pediatric cardiology, Heart CenterKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Saeed Almanie
- Department of pediatric cardiology, Heart CenterKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Abdullah Alwadai
- Department of pediatric cardiology, Heart CenterKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| |
Collapse
|
9
|
Romano DN, Smith NK, Itagaki S, Bekki Y, Gunasekaran G, Zerillo J. A Case Report of Venoarterial ECMO as Salvage Therapy for Prolonged Cardiac Arrest Following Post-Reperfusion Intracardiac Thrombosis During Orthotopic Liver Transplantation. Semin Cardiothorac Vasc Anesth 2020; 25:62-66. [PMID: 32838666 DOI: 10.1177/1089253220952628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this report we describe the use of intraoperative venoarterial ECMO as salvage therapy in a unique case of post-reperfusion intracardiac thrombosis during liver transplantation with prolonged ACLS and coagulopathy. The limited literature on intraoperative ECMO as salvage therapy in liver transplantation is reviewed.
Collapse
Affiliation(s)
- Diana N Romano
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Yuki Bekki
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jeron Zerillo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
10
|
Aladağ Çiftdemir N, Gökalp S, Eren T. Is Immunosuppressive and Thrombolytic Therapy Really Effective in a Patient With Intracardiac Thrombosis and Pulmonary Artery Aneurysm due to Behçet's Disease? Arch Rheumatol 2019; 34:451-6. [PMID: 32010896 DOI: 10.5606/ArchRheumatol.2019.7169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/23/2019] [Indexed: 11/21/2022] Open
Abstract
Behçet's disease (BD) is a rare, multisystemic, chronic vasculitic disorder with unknown etiology. Intracardiac thrombus formation and pulmonary artery aneurysm in BD are very rare. The treatment protocol in patients with vascular involvement, particularly those with pulmonary artery aneurysm accompanied by thrombosis, have not been clearly defined. In this article, we report an exceptional case, who had been treated unsuccessfully with a combination of anti-inflammatory/immunosuppressive therapy and thrombolytic agents, to discuss the poor prognosis of pulmonary artery aneurysm accompanying intracardiac thrombosis in juvenile BD.
Collapse
|
11
|
Gold AK, Patel PA, Lane-Fall M, Gutsche JT, Lauter D, Zhou E, Guelaff E, MacKay EJ, Weiss SJ, Baranov DJ, Valentine EA, Feinman JW, Augoustides JG. Cardiovascular Collapse During Liver Transplantation-Echocardiographic-Guided Hemodynamic Rescue and Perioperative Management. J Cardiothorac Vasc Anesth 2018. [PMID: 29525193 DOI: 10.1053/j.jvca.2018.01.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew K Gold
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meghan Lane-Fall
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek Lauter
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric Guelaff
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dimitri J Baranov
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A Valentine
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
12
|
Alekberova ZS, Ovcharov PS, Lisitsyna TA, Volkov AV, Popkova TV. [Behçet's disease: Intracardiac thrombosis (a description of two cases and a review of literature)]. TERAPEVT ARKH 2017. [PMID: 28631704 DOI: 10.17116/terarkh201789579-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behçet's disease (BD) is systemic vasculitis of unknown etiology, which is more common in the countries located along the Great Silk Road. The disease is diagnosed if a patient has 4 key diagnostic signs: aphthous stomatitis, genital sores, and eye and skin lesions. Vascular diseases referred to as minor criteria for BD are characterized by the formation of aneurysms and thrombosis, predominantly in the venous bed. In venous disorders, a blood clot can form in any vessel, including caval, cerebral, pulmonary, and other veins. The paper describes two clinical cases of BD with intracardiac thrombosis. In one case, a 24-year-old male patient with a documented diagnosis of BD, echocardiography revealed a left ventricular spontaneous echo contrast phenomenon that disappeared due to immunosuppressive therapy. The other case was a 34-year-old female patient, in whom the diagnosis was based on the international disease criteria: aphthous stomatitis, skin lesions (pseudopustulosis, erythema nodosum), and genital sores. Computed tomographic angiography showed a 3.7×2.2-cm mass (thrombus) in the right atrium. In addition, blood clots were present in the hepatic and inferior vena cava. No abnormalities in the coagulation system were found in both cases.
Collapse
Affiliation(s)
- Z S Alekberova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - P S Ovcharov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T A Lisitsyna
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A V Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| |
Collapse
|
13
|
Ulloa-Ricardez A, Romero-Espinoza L, Estrada-Loza MDJ, González-Cabello HJ, Núñez-Enríquez JC. Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter. Pediatr Neonatol 2016; 57:288-94. [PMID: 26747618 DOI: 10.1016/j.pedneo.2015.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/17/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Central venous catheter (CVC) installation is essential for the treatment of critically ill neonates; however, it is associated with the development of neonatal intracardiac thrombosis, which is a complication that is associated with a poor prognosis. We aimed to identify specific risk factors for the development of intracardiac thrombosis in the right atrium (RA) and superior vena cava (SVC) related to the use of CVC in critically ill neonates. METHODS A case-control study was conducted at the tertiary referral neonatal intensive care unit of the Pediatric Hospital Siglo XXI in Mexico City, Mexico from 2008 to 2013. The included cases (n = 43) were de novo patients with intracardiac thrombosis in the RA and SVC diagnosed by echocardiography. The controls (n = 43) were neonates without intracardiac thrombosis or thrombosis at other sites. A logistic regression analysis was conducted, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS The independent risk factors for intracardiac thrombosis in the RA and SVC were the surgical cut-down insertion technique (OR = 2.98; 95% CI: 1.18-9.10), a maternal history of gestational diabetes/diabetes mellitus (OR = 10.64; 95% CI: 1.13-121.41), Staphylococcus epidermidis infection (OR = 7.09; 95% CI: 1.09-45.92), and CVC placement in the SVC (OR = 5.77; 95% CI: 1.10-30.18). CONCLUSION This study allowed us to identify several contributing factors to the development of intracardiac thrombosis in the RA and SVC related to the installation of a CVC in a subgroup of critically ill neonates. Multicenter and well-designed studies with a larger number of patients could help validate our findings and/or identify other risk factors that were not identified in the present study.
Collapse
Affiliation(s)
- Alfredo Ulloa-Ricardez
- Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico
| | - Lizett Romero-Espinoza
- Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico
| | - María de Jesús Estrada-Loza
- Department of Pediatric Cardiology, Pediatric Hospital, The Siglo XXI National Medical Center, Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico
| | - Héctor Jaime González-Cabello
- Neonatal Intensive Care Unit, Pediatric Hospital, The Siglo XXI National Medical Center Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Research Unit in Clinical Epidemiology, Pediatric Hospital, The Siglo XXI National Medical Center, Mexican Institute of Social Security, Delegación Cuauhtémoc, Mexico City, Mexico.
| |
Collapse
|
14
|
Voigtlaender M, Conradi L, Hinsch A, Langer F. Right Atrial Thrombosis in Antiphospholipid Syndrome with Secondary Immune Thrombocytopenia. Thorac Cardiovasc Surg Rep 2015; 4:40-3. [PMID: 26693127 PMCID: PMC4670312 DOI: 10.1055/s-0035-1549841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/18/2015] [Indexed: 01/19/2023] Open
Abstract
Background Antiphospholipid syndrome (APS) is an acquired thrombophilia that can be associated with decreased platelet counts. Case A 67-year-old woman presented with thrombocytopenia and a symptomatic right atrial mass suspicious of cardiac myxoma. Prolongation of the activated partial thromboplastin time (aPTT) was caused by a strong lupus anticoagulant, and bone marrow cytology was consistent with accelerated platelet clearance. The patient underwent uneventful resection of the atrial tumor, which turned out to be a calcified fibrin-rich thrombus. Definitive APS was diagnosed and long-term anticoagulation recommended. Conclusion When evaluating patients with right atrial masses, findings of thrombocytopenia and/or aPTT prolongation should raise the suspicion of APS-associated thrombosis.
Collapse
Affiliation(s)
- Minna Voigtlaender
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik, Onkologisches Zentrum, Hamburg, Germany
| | - Lenard Conradi
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum, Hamburg, Germany
| | - Andrea Hinsch
- Universitätsklinikum Hamburg-Eppendorf, Institut für Pathologie, Hamburg, Germany
| | - Florian Langer
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik, Onkologisches Zentrum, Hamburg, Germany
| |
Collapse
|
15
|
Abstract
Thrombosis is a potential life-threatening complication in patients undergoing cardiac surgery. Various clinical and heritable conditions, like cancer, trauma, immobilization, the presence of factor V Leiden or prothrombin 20210A, deficiency of or resistance to the inhibitor proteins C, S, or antithrombin, elevated levels of coagulation proteins, antiphospholipid antibody syndrome, pregnancy, and the use of exogenous hormones, may contribute to catastrophic thrombosis. Massive thrombi with cerebrovascular and cardiovascular events develop in patients with polycythemia vera (PV). However, thrombus formation in the cardiac chambers is extremely rare. We report a case of massive intracardiac thrombosis in a patient undergoing coronary artery bypass grafting.
Collapse
Affiliation(s)
- Sujatha P Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Apostolakis
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Main Campus, Cleveland, Ohio, USA
| |
Collapse
|
16
|
Wittekind SG, Salerno JC, Rubio AE. Pacemaker-associated cyanosis in an adolescent: The answer hiding behind shadows. Images Paediatr Cardiol 2012; 14:6-10. [PMID: 23720693 PMCID: PMC3663149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lead thrombosis is a recognized complication of permanent transvenous pacemaker (PM) implantation. We present the interesting case of an adolescent with a dual-chamber PM presenting with fatigue and hypoxemia. Due to limitations of various imaging modalities, the diagnosis was difficult. She was eventually diagnosed with intracardiac PM lead thrombi obstructing tricuspid valve inflow. The pediatric literature on PM lead thrombosis is also briefly reviewed.
Collapse
Affiliation(s)
- SG Wittekind
- Pediatric Residency Program, University of Washington, Seattle, WA.,
Samuel G. Wittekind, Pediatric Resident, Pediatric Residency Program, Seattle Children's / University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Room A-5950, Seattle, WA 98105. Telephone: 206-388-7301; Fax: 206-985-3157;
| | - JC Salerno
- Division of Cardiology, Seattle Children's, Seattle, WA
| | - AE Rubio
- Division of Cardiology, Seattle Children's, Seattle, WA
| |
Collapse
|