Chen Kai, Williams Suzan, Chan Anthony K C, Mondal Tapas K
McMaster University, Hamilton bHospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Blood Coagul Fibrinolysis. 2013 Apr;24(3):221-30. doi: 10.1097/MBC.0b013e32835bfd85.
The management of cardiomyopathy in pediatric patients is complicated by the risk of cardiac-associated embolism. This review examines the incidence, risk factors, and treatment of embolism in dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM), and noncompaction of the left ventricular myocardium (NLVM) in children. The reported incidence of embolism for DCM ranges from 1 to 16%. Left ventricular ejection fraction below 25% or fractional shortening below 15% are major risk factors for intracardiac thrombus formation in this group. The risk of embolism for RCM ranges from 12 to 33%. Atrial dilation is considered the major risk factor. The reported incidence of embolism for NLVM ranges from 0 to 38%, with most studies indicating an absence of detectable thrombus or embolus. Severe systolic dysfunction exacerbates the risk of embolism in this group. On the basis of these risk factors, we propose an algorithm for the management of embolism in these groups of patients.
小儿患者心肌病的管理因心脏相关栓塞风险而变得复杂。本综述探讨了儿童扩张型心肌病（DCM）、限制型心肌病（RCM）和左心室心肌致密化不全（NLVM）中栓塞的发生率、危险因素及治疗。报道的DCM栓塞发生率为1%至16%。该组中左心室射血分数低于25%或缩短分数低于15%是心内血栓形成的主要危险因素。RCM的栓塞风险为12%至33%。心房扩张被认为是主要危险因素。报道的NLVM栓塞发生率为0%至38%，大多数研究表明未检测到血栓或栓子。严重收缩功能障碍会增加该组患者的栓塞风险。基于这些危险因素，我们提出了针对这些患者群体栓塞管理的算法。
