Prevalence of intracardiac shunting in children with sickle cell disease and stroke.
Prevalence of intracardiac shunting in children with sickle cell disease and stroke.
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DOI：
10.1016/j.jpeds.2009.10.012
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发表时间：
2010-04
影响因子：
5.1
通讯作者：
Buchanan, George R.
中科院分区：
文献类型：
--
作者：
Dowling, Michael M.;Lee, Nancy;Quinn, Charles T.;Rogers, Zora R.;Boger, Deborah;Ahmad, Naveed;Ramaciotti, Claudio;Buchanan, George R.
确定镰状细胞病（SCD）和卒中儿童中潜在心内分流（包括卵圆孔未闭（PFO））的患病率。我们对40名患有SCD（39名血红蛋白SS和1名镰状β 0地中海贫血）和早期卒中（30名明显卒中，10名无症状梗死）的儿童进行了经胸超声心动图（TTE）检查。我们比较了3种TTE技术：常规二维成像、彩色多普勒超声和静脉内搅拌盐水造影剂注射检测心内分流。我们还评估了有和没有分流的儿童的临床，实验室和放射摄影结果。我们在40例SCD和早期卒中儿童中发现了10例PFO或其他潜在的心内分流（25%; 95%CI，11.6-38.4）。对比TTE，我们未能发现潜在的分流在2名儿童。在60例脑卒中但无SCD的儿童对照组中，回顾性临床超声心动图检查发现60例中有7例发生PFO（11.7%; 95%CI，3.6-19.8）。与心内分流显著相关的临床特征是血管闭塞危象时的卒中（P = 0.026）和卒中发作时的头痛（P = 0.014）。四分之一的SCD和中风儿童有潜在的心内分流。最佳分流检测需要结合超声心动图技术。心内分流可能是SCD儿童卒中的一个危险因素，因为他们易发生血栓形成和右心压力升高，这可能促进心内分流处的反常栓塞。
To determine the prevalence of potential intracardiac shunts, including patent foramen ovale (PFO), in children with sickle cell disease (SCD) and stroke. We performed a transthoracic echocardiogram (TTE) on 40 children with SCD (39 with hemoglobin SS and 1 with sickle-beta0 thalassemia) and earlier stroke (overt stroke in 30, silent infarction in 10). We compared 3 TTE techniques: conventional 2-dimensional imaging, color Doppler ultrasound, and intravenous agitated saline contrast injection for the detection of intracardiac shunts. We also evaluated the clinical, laboratory, and radio-graphic findings of the children with and without shunts. We identified PFO or other potential intracardiac shunts in 10 of 40 children with SCD and earlier stroke (25%; 95% CI, 11.6-38.4). With contrasted TTE, we failed to detect potential shunts in 2 children. In a comparison group of 60 children with stroke but without SCD, retrospective review of clinical echocardiograms identified PFO in 7 of 60 (11.7%; 95% CI, 3.6-19.8). Clinical features significantly associated with the presence of intracardiac shunts were stroke in the setting of vaso-occlusive crisis (P = .026) and headache at stroke onset (P = .014). One-quarter of children with SCD and stroke have potential intracardiac shunts. A combination of echocardiographic techniques is required for optimal shunt detection. Intracardiac shunting could be a risk factor for stroke in children with SCD because they are predisposed to thrombosis and elevations of right heart pressure, which could promote paradoxical embolization across an intracardiac shunt.
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DOI：
10.1016/j.echo.2007.06.001
发表时间：
2008-10-01
影响因子：
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作者：
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