Detection of occult thrombosis in individuals with Fontan circulation by cardiac MRI.
| Title: | Detection of occult thrombosis in individuals with Fontan circulation by cardiac MRI. |
|---|---|
| Authors: | Curtis SF; Department of Internal Medicine-Pediatrics, Duke University Medical Center, Durham, NC, USA.; Cicioni M; Department of Pediatric, Duke University Medical Center, Durham, NC, USA.; Mullikin A; Duke University School of Medicine, Durham, NC, USA.; Williams J; Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.; Campbell JM; Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.; Barker PCA; Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.; McCrary AW; Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA. |
| Source: | Cardiology in the young [Cardiol Young] 2024 Jul; Vol. 34 (7), pp. 1544-1549. Date of Electronic Publication: 2024 Mar 20. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Cambridge University Press Country of Publication: England NLM ID: 9200019 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1467-1107 (Electronic) Linking ISSN: 10479511 NLM ISO Abbreviation: Cardiol Young Subsets: MEDLINE |
| Imprint Name(s): | Publication: : Cambridge : Cambridge University Press; Original Publication: Chapel Hill, NC : World Publishers, c1991- |
| MeSH Terms: | Fontan Procedure*/adverse effects ; Heart Defects, Congenital*/surgery ; Thrombosis*/etiology ; Thrombosis*/diagnostic imaging ; Thrombosis*/epidemiology; Magnetic Resonance Imaging, Cine/methods ; Magnetic Resonance Imaging/methods ; Humans ; Female ; Retrospective Studies ; Male ; Child, Preschool ; Child ; Adolescent ; Prevalence ; Adult ; Young Adult ; Registries ; Infant |
| Abstract: | Objective: Identifying thrombus formation in Fontan circulation has been highly variable, with reports between 17 and 33%. Initially, thrombus detection was mainly done through echocardiograms. Delayed-enhancement cardiac MRI is emerging as a more effective imaging technique for thrombus identification. This study aims to determine the prevalence of occult cardiac thrombosis in patients undergoing clinically indicated cardiac MRI.; Methods: A retrospective chart review of children and adults in the Duke University Hospital Fontan registry who underwent delayed-enhancement cardiac MRI. Individuals were excluded if they never received a delayed-enhancement cardiac MRI or had insufficient data. Demographic characteristics, native heart anatomy, cardiac MRI measurements, and thromboembolic events were collected for all patients.; Results: In total, 119 unique individuals met inclusion criteria with a total of 171 scans. The median age at Fontan procedure was 3 (interquartile range 1, 4) years. The majority of patients had dominant systemic right ventricle. Cardiac function was relatively unchanged from the first cardiac MRI to the third cardiac MRI. While 36.4% had a thrombotic event by history, only 0.5% (1 patient) had an intracardiac thrombus detected by delayed-enhancement cardiac MRI.; Conclusions: Despite previous echocardiographic reports of high prevalence of occult thrombosis in patients with Fontan circulation, we found very low prevalence using delayed-enhancement cardiac MRI. As more individuals are reaching adulthood after requiring early Fontan procedures in childhood, further work is needed to develop thrombus-screening protocols as a part of anticoagulation management. |
| Contributed Indexing: | Keywords: Fontan-associated thrombi; cardiac MRI; echocardiogram |
| Entry Date(s): | Date Created: 20240320 Date Completed: 20241025 Latest Revision: 20241029 |
| Update Code: | 20260130 |
| DOI: | 10.1017/S1047951124000489 |
| PMID: | 38506050 |
| Database: | MEDLINE |
Journal Article