Introduction: Intracardiac thrombosis in dilated cardiomyopathy (DCMP) could occur with subsequent serious morbidity. This study was aimed to assess risk factors and outcome of intracardiac thrombosis in children with DCMP.
Patients and Method: Retrospective review of clinical records was done in 83 children with DCMP who was diagnosed from January 1995 to December 2008.
Results: Intracardiac thrombi were detected in five patients (6.0%) (LV (3) and LA (1), RV (1) respectively). The etiology of DCMP was idiopathic (2), VSD with pulmonary hypertension (1), repaired VSD with complete atrioventricular block (1), and after chemotherapy for AML (1). Average duration from diagnosis to detection of thrombi was 9.4 months (0~23mo). One showed LA thrombus in the pouch of interatrial septum at the time of diagnosis. The other 4 patients had thrombi in ventricles when rapid deterioration of ventricular function occurred. All showed poor ejection fraction of left ventricle (15.5~27%). Cerebral infarction of left MCA territory was noted in one with LV thrombus after CRT implantation. One showed LV thrombus after volume reduction operation of LV. RV thrombus was found in unrepaired VSD with pulmonary hypertension. All were treated with heparinization (15~20U/kg/hr, average treatment duration 7.8 days). LV thrombectomy was performed in a patient with postoperative volume reduction operation. Three showed complete absorption without further embolic complications after anticoagulation. Two patients died of respiratory infection and pump failure.
Conclusion; Careful evaluation and aggressive anticoagulation are necessary for preventing intracardiac thrombus in children with poor ventricular function.