Medical and Invasive Management of Cardiac Thrombosis in Children with Congenital and Acquired Heart Disease
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Cardiology/CT Surgery (K Gist, Section Editor)
Medical and Invasive Management of Cardiac Thrombosis in Children with Congenital and Acquired Heart Disease John S. Kim, MD MS1,* Michele M. Loi, MD2 Matthew L. Stone, MD PhD3 Christina J. VanderPluym, MD4 Address *,1 Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO, 80045, USA Email: [email protected] 2 Divisions of Critical Care and Hematology, Oncology, and Bone Marrow Transplant, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA 3 Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA 4 Department of Cardiology, Harvard Medical School, Boston, MA, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Cardiology/CT Surgery Keywords Venous thromboembolism I Intracardiac thrombosis I Anticoagulation I Thrombolysis I Direct thrombin inhibitors
Abstract Purpose of review In this manuscript, we review the diagnosis, causes, and management of cardiac thrombosis in children with congenital and acquired heart disease. Indications for invasive management and surgery are discussed. The differential diagnostic considerations and management of cardiac thromboses will be reviewed, including those that occur as a consequence of repair and palliation of congenital heart disease. Recent findings The definition of venous thromboembolism has recently been expanded to include thromboses within both the right and left heart chambers. Direct thrombin inhibitors (DTIs) and direct oral anticoagulants (DOACs) are emerging as treatment alternatives to the heparins and vitamin K antagonists for the management of thrombosis in pediatric heart disease.
Cardiology/CT Surgery (K Gist, Section Editor) Summary Thrombosis within the heart occurs as a consequence of abnormalities and alterations in blood flow resulting in stasis and turbulence. Children with acquired and congenital heart disease carry a number of risk factors in Virchow’s triad. Thrombosis can occur throughout any part of the cardiovascular system in congenital heart disease and after surgery for repair or palliation of defects.
Introduction Thrombosis is a common morbidity in children with congenital and acquired heart disease that is often life threatening. The risk factors for thrombosis described by Rudolph Virchow nearly 150 years ago are ever present in children with heart disease: hypercoagulability, venous stasis, and endothelial injury. High-risk populations in pediatric cardiology often manifest all three risk factors, especially after congenital heart surgery (Fig. 1). Additionally, infants and children maintain hemostatic balance in the context of developmental hemostasis
Fig. 1. Virchow’s triad in pediatric heart disease.
with different levels of coagulation proteins, which only reach normal adult levels in adolescence [1]. Thrombosis can occur thr
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