Cor Vasa 2013, 55(2):e170-e175 | DOI: 10.1016/j.crvasa.2013.03.006

Pulmonary thromboembolism in congenital heart defects with severe pulmonary arterial hypertension

Monika Kaldarárová^a,*, Iveta Šimková^b, Tatiana Valkovičová^b, Anna Remková^c, Vladimír Neuschl^d

^a Národný ústav srdcových a cievnych chorôb, a. s. - Detské kardiocentrum, Bratislava, Slovenská republika

^b Kardiologická klinika Slovenskej zdravotníckej univerzity a Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

^c Centrum hemostázy a trombózy HemoMedika, Bratislava, Slovenská republika

^d Inštitút zobrazovacej diagnostiky, Trnava, Slovenská republika

Introduction: Congenital heart defect (CHD) with shunt can lead to severe, even irreversible pulmonary arterial hypertension (PAH); in extreme form to Eisenmenger syndrome (ES). Despite relatively good long-term survival, these patients often suffer from cyanosis and multisystemic dysfunction; where pulmonary artery thrombosis can be a potentially fatal complication. Together with bleeding these are the most frequent causes of non-cardiac death in patients with severe PAH due to CHD.

Patients and methods: Prospective study of 40 patients with severe PAH due to CHD (28 female/12 male, median age 41.5 years) was performed, with the aim to analyze the presence of pulmonary artery thrombosis and correlating anatomical and laboratory risk factors.

Results: Previous thrombosis and/or thromboembolic event was found in 7 patients (17.5%). Significant difference in cyanotic versus non-cyanotic patients were in red blood count parameters: median hemoglobin level - 195 vs 141 (p < 0.0001), median erythrocytes count 6.62 vs 4.88 × 1012/l (p < 0.0001), median hematocrite 0.58 vs 0.44 (p < 0.0001). Laboratory findings causing increased risk for thrombosis were: increased thrombocytes aggregation in 15 patients (37.5%), hypercoagulation in 5 patients (12.5%) and endothelial dysfunction in 8 patients (20%). Anatomical risk factor - severe pulmonary artery dilatation (> 40 mm in female and > 45 mm in male) was found in 19 patients (51.4%).

Conclusions: Patients with severe PAH due to CHD represent a high-risk group for pulmonary artery thrombosis with morphological and flow pathology combined with secondary erythrocytosis and coagulation abnormalities. A relatively high incidence of platelet hyperaggregability shown in our study would propose that aspirin therapy might be considered in some highly selected patients with severe PAH due to CHD. Further studies though are needed to support this data.

Keywords: Congenital heart defects; Cyanosis; Eisenmenger syndrome; Pulmonary arterial hypertension; Pulmonary artery dilatation; Pulmonary artery thrombosis

Received: January 23, 2013; Revised: March 8, 2013; Accepted: March 18, 2013; Published: April 1, 2013  Show citation