Transesophageal Echocardiography of Intracardiac Thrombus in Congenital Heart Disease and Atrial Flutter: The Importance of Thorough Examination of the Fontan

Autor: Vivian Wei Cui, Molly Philips, David A. Roberson, Frank Zimmerman, Nida Yousef, Ira Shetty
Rok vydání: 2014
Předmět:
Adult
Heart Defects
Congenital
Male
congenital
hereditary
and neonatal diseases and abnormalities
medicine.medical_specialty
Adolescent
Heart Diseases
Heart disease
medicine.medical_treatment
Population
Electric Countershock
Fontan Procedure
Cardioversion
Intracardiac injection
Diagnosis
Differential
Young Adult
Internal medicine
medicine
Humans
Heart Atria
cardiovascular diseases
Child
education
Aged
Retrospective Studies
education.field_of_study
Electric Cardioversion
business.industry
Reproducibility of Results
Thrombosis
Atrial fibrillation
Middle Aged
medicine.disease
Cardiac surgery
Atrial Flutter
Child
Preschool
Pediatrics
Perinatology and Child Health
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
human activities
Echocardiography
Transesophageal
Atrial flutter
Follow-Up Studies
Zdroj: Pediatric Cardiology. 35:1099-1107
ISSN: 1432-1971
0172-0643
DOI: 10.1007/s00246-014-0902-x
Popis: Transesophageal echocardiography (TEE) is used in atrial flutter or fibrillation (AFF) before electric cardioversion to detect intracardiac thrombi. Previous studies have described the use of TEE to diagnose intracardiac thrombi in the left atrium and left atrial appendage, which has an incidence of 8 % among patients without congenital heart disease (CHD). In their practice the authors have noted a significant incidence of intracardiac thrombi in other structures of patients with CHD and AFF. This study aimed to determine the incidence and location of intracardiac thrombi using TEE in patients with CHD requiring electric cardioversion of AFF and to compare the use of TEE and transthoracic echo (TTE) to detect intracardiac thrombus in this population. A retrospective chart review of TEE and TTE findings for all patients with CHD who had electric cardioversion of AFF at our institution from 2005 to 2013 was conducted. The diagnosis, presence, and location of intracardiac thrombus were determined. The TEE and TTE results were compared. The study identified 27 patients with CHD who met the study entry criteria at our institution between 2005 and 2013. Seven of these patients had a single ventricle with Fontan palliation. All the patients presented with AFF and had TEE before electric cardioversion. No patients were excluded from the study. The patients ranged in age from 2 to 72 years (median, 21 years) and weighed 17-100 kg (median, 65 kg). The duration of AFF before TEE and attempted cardioversion ranged from 1 day to 3 weeks (median, 3.5 days). Intracardiac thrombus was present in 18 % (5/27) of the patients and in 57 % (4/7) of the Fontan patients with AFF. No embolic events were reported acutely or during a 6-month follow-up period. Among patients with CHD who present with AFF, a particularly high incidence of intracardiac thrombi is present in the Fontan patients that may be difficult to detect by TTE. Thorough TEE examination of the Fontan and related structures is indicated before electric cardioversion of AFF. The incidence of intracardiac thrombus in CHD patients is more than double that reported in non-CHD patients.
Databáze: OpenAIRE
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