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Prevalence of cerebral and pulmonary thrombosis in patients with cyanotic congenital heart disease
  1. A S Jensen1,
  2. L Idorn1,
  3. C Thomsen2,
  4. P von der Recke3,
  5. J Mortensen4,
  6. K E Sørensen5,
  7. U Thilén6,
  8. E Nagy7,
  9. K F Kofoed1,
  10. S R Ostrowski8,
  11. L Søndergaard1
  1. 1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  3. 3Amager Radiological Clinic, Copenhagen, Denmark
  4. 4Department of Clinical Physiology & Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  5. 5Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
  6. 6Department of Cardiology, Lund University Hospital, Lund, Sweden
  7. 7Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  8. 8Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Annette Schophuus Jensen, Department of Cardiology, section 2014, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark; schophuus{at}gmail.com

Abstract

Background Patients with cyanotic congenital heart disease (CCHD) have a high prevalence of thrombosis, the most frequently described locations being the cerebral and pulmonary vessels. The reported prevalence of both cerebral infarction and pulmonary thrombosis has been highly variable. The aim of this study was to examine the prevalence of both cerebral and pulmonary thrombosis in CCHD according to medical history and imaging. In addition, the role of known erythrocytosis and haemostatic abnormalities as risk factors was evaluated.

Methods and results A cross-sectional descriptive study examining 98 stable adult patients with CCHD with a medical questionnaire, blood samples, MRI of the cerebrum (n=72), multidetector CT imaging (MDCT) of the thorax (n=76) and pulmonary scintigraphy (ventilation/perfusion/single-photon emission computerised tomography/CT) (n=66). The prevalence of cerebral infarction and pulmonary thrombosis according to imaging were 47% and 31%, respectively. Comparing the findings with previous medical history revealed a large under-reporting of thrombosis with only 22% of the patients having a clinical history of stroke and 25% of pulmonary thrombosis. There was no association between the degree of erythrocytosis or haemostatic abnormalities and the prevalence of thrombosis.

Conclusions Patients with CCHD have a prevalence of both cerebral and pulmonary thrombosis of around 30%–40%, which is much higher than that reported previously. Furthermore, there is a large discrepancy between clinical history and imaging findings, suggesting a high prevalence of silent thrombotic events. Neither erythrocytosis nor haemostatic abnormalities were associated with the prevalence of thrombosis in patients with CCHD.

Trial registration number http://www.cvk.sum.dk/CVK/Home/English.aspx (H-KF-2006-4068).

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