TY - JOUR
T1 - Prevalence of Intracardiac Shunting in Children with Sickle Cell Disease and Stroke
AU - Dowling, Michael M.
AU - Lee, Nancy
AU - Quinn, Charles T.
AU - Rogers, Zora R.
AU - Boger, Deborah
AU - Ahmad, Naveed
AU - Ramaciotti, Claudio
AU - Buchanan, George R.
N1 - Funding Information:
Supported by the National Heart, Lung, and Blood Institute Comprehensive Sickle Cell Center Program ( U54 HL 70588 ) and the Children's Clinical Research Advisory Committee at Children's Medical Center Dallas . M.D. and C.Q. are supported by the North and Central Texas Clinical and Translational Science Initiative from the NIH KL2 RR024983 . M.D. is supported by the First American Real Estate Information Services, Inc . The authors declare no conflicts of interest.
PY - 2010/4
Y1 - 2010/4
N2 - Objective: To determine the prevalence of potential intracardiac shunts, including patent foramen ovale (PFO), in children with sickle cell disease (SCD) and stroke. Study design: 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 radiographic findings of the children with and without shunts. Results: 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). Conclusion: 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.
AB - Objective: To determine the prevalence of potential intracardiac shunts, including patent foramen ovale (PFO), in children with sickle cell disease (SCD) and stroke. Study design: 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 radiographic findings of the children with and without shunts. Results: 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). Conclusion: 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.
UR - http://www.scopus.com/inward/record.url?scp=77949490150&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77949490150&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2009.10.012
DO - 10.1016/j.jpeds.2009.10.012
M3 - Article
C2 - 20022343
AN - SCOPUS:77949490150
SN - 0022-3476
VL - 156
SP - 645
EP - 650
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 4
ER -