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一名先天性心脏病儿科患者停用抗凝剂后发生肾梗死

Renal Infarction Following Anticoagulant Discontinuation in a Pediatric Patient With Congenital Heart Disease.

作者信息

Asami Yusuke, Kajiho Yuko, Kinumaki Akiko, Shiraga Kazuhiro, Inuzuka Ryo

机构信息

Department of Pediatrics, The University of Tokyo, Tokyo, JPN.

出版信息

Cureus. 2025 Mar 13;17(3):e80540. doi: 10.7759/cureus.80540. eCollection 2025 Mar.

Abstract

Renal infarctions are rare in pediatric patients. While cardiogenic risk has been documented in adults, the association between renal infarction and congenital heart disease in children is seldom reported. Consequently, the pathogenesis and risk remain unclear. This report aims to highlight a potential association between anticoagulant discontinuation and renal infarction in pediatric patients with congenital heart disease. Herein, we present the case of a nine-year-old boy who underwent Fontan surgery for a left-sided, morphologic right ventricle and for whom anticoagulants were discontinued following oral bleeding. The patient presented with sudden abdominal pain and was diagnosed with renal infarction based on his medical history and contrast-enhanced CT findings. Serum D-dimer levels were later found to be elevated. Anticoagulant discontinuation in patients with congenital heart disease is a risk factor for renal infarction, necessitating intensified monitoring. In at-risk patients, renal infarction should be considered in the differential diagnosis of acute abdomen.

摘要

肾梗死在儿科患者中较为罕见。虽然成人的心源性风险已有文献记载,但儿童肾梗死与先天性心脏病之间的关联鲜有报道。因此,其发病机制和风险仍不明确。本报告旨在强调先天性心脏病儿科患者停用抗凝剂与肾梗死之间的潜在关联。在此,我们报告一例9岁男孩的病例,该男孩因左侧形态学右心室接受了Fontan手术,术后因口腔出血停用了抗凝剂。患者出现突发腹痛,根据其病史和增强CT检查结果被诊断为肾梗死。后来发现血清D - 二聚体水平升高。先天性心脏病患者停用抗凝剂是肾梗死的一个危险因素,需要加强监测。对于有风险的患者,在急性腹痛的鉴别诊断中应考虑肾梗死。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39a2/11993470/f7011cdd52d0/cureus-0017-00000080540-i01.jpg

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