CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Pulmonary thrombosis in adults with Eisenmenger syndrome
Candice K. Silversides, MD*,*,
John T. Granton, MD ,
Eli Konen, MD ,
Michelle A. Hart, BSc*,
Gary D. Webb, MD, FACC* and
Judith Therrien, MD*
* Toronto Congenital Cardiac Centre for Adults, Toronto, Canada
Division of Respirology, University Health Network, University of Toronto, Toronto, Canada
Department of Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Canada
Manuscript received May 5, 2003;
revised manuscript received June 30, 2003,
accepted July 1, 2003.
* Reprint requests and correspondence: Dr. Candice K. Silversides, Beth Israel Deaconess Medical Center, Cardiovascular Division, 330 Brookline Avenue, E/RW-453, Boston, Massachusetts 02215, USA.
csilvers{at}caregroup.harvard.edu
OBJECTIVES: We sought to determine the prevalence of pulmonary artery thrombosis in patients with Eisenmenger syndrome and to identify individuals at highest risk.
BACKGROUND: Eisenmenger syndrome is associated with pulmonary arterial thrombus formation. Both the prevalence and the determinants of pulmonary arterial thrombosis are unknown.
METHODS: This is a review of patients with Eisenmenger syndrome seen at the Toronto Congenital Cardiac Centre for Adults, Canada. Patients underwent a contrast-enhanced computed tomographic (CT) scan of the thorax.
RESULTS: Forty-nine consecutive patients with Eisenmenger syndrome were seen in our hospital. Fifteen patients did not undergo CT angiograms; therefore, 34 patients (mean age 42 ± 10 years) were included in the study. Responsible shunts included ventricular septal defect (65%), atrial septal defect (15%), patent ductus arteriosus (9%), and other (11%). The prevalence of proximal pulmonary artery thrombus was 21% (7/34) of patients. Evidence of more distal vessel thrombosis was observed in 43% (3/7) of the patients who had visible thrombus in the proximal pulmonary arteries. Patients with thrombus were more likely to be female (86% vs. 37%, p = 0.04) and to have lower oxygen saturations (72% ± 9% vs. 85% ± 6%, p = 0.01). Differences in functional status did not identify patients at highest risk for thrombosis.
CONCLUSIONS: Patients with Eisenmenger syndrome have a substantial risk of pulmonary artery thrombus formation. Women and patients with lower oxygen saturations are at the highest risk of developing thrombosis. In the context of an increased bleeding tendency in these patients, the role of anticoagulation treatment needs to be determined.
|
Abbreviations and Acronyms
| | CT | = computed tomography/tomographic | | INR | = international normalized ratio | | NYHA | = New York Heart Association |
|
This article has been cited by other articles:
|
|
|
|
 
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
e143 - e263.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
1890 - 1947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
e714 - e833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
2395 - 2451.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. S. Broberg, M. Ujita, S. Prasad, W. Li, M. Rubens, B. E. Bax, S. J. Davidson, B. Bouzas, J. S. R. Gibbs, J. Burman, et al.
Pulmonary Arterial Thrombosis in Eisenmenger Syndrome Is Associated With Biventricular Dysfunction and Decreased Pulmonary Flow Velocity
J. Am. Coll. Cardiol.,
August 14, 2007;
50(7):
634 - 642.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Jensen, K. Iversen, N. G. Vejlstrup, and L. Sondergaard
Pulmonary Artery Thrombosis and Hemoptysis in Eisenmenger Syndrome
Circulation,
June 19, 2007;
115(24):
e632 - e634.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.-P. Diller and M. A. Gatzoulis
Pulmonary Vascular Disease in Adults With Congenital Heart Disease
Circulation,
February 27, 2007;
115(8):
1039 - 1050.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. H. Caramuru, A. A. Lopes, N. Y. Maeda, V. D. Aiello, and C. C. Filho
Long-term Behavior of Endothelial and Coagulation Markers in Eisenmenger Syndrome
Clinical and Applied Thrombosis/Hemostasis,
April 1, 2006;
12(2):
175 - 183.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. L. Benza, B. K. Rayburn, J. A. Tallaj, C. S. Coffey, L. J. Pinderski, S. V. Pamoukian, and R. C. Bourge
Efficacy of bosentan in a small cohort of adult patients with pulmonary arterial hypertension related to congenital heart disease.
Chest,
April 1, 2006;
129(4):
1009 - 1015.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C Broberg, M Ujita, S Babu-Narayan, M Rubens, S K Prasad, J S R Gibbs, and M A Gatzoulis
Massive pulmonary artery thrombosis with haemoptysis in adults with Eisenmenger's syndrome: a clinical dilemma
Heart,
November 1, 2004;
90(11):
e63 - e63.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. P. Graham Jr
The year in congenital heart disease
J. Am. Coll. Cardiol.,
June 2, 2004;
43(11):
2132 - 2141.
[Full Text]
[PDF]
|
|
|
|
