Author + information
- Received January 3, 2007
- Revision received April 10, 2007
- Accepted April 15, 2007
- Published online August 14, 2007.
- Craig S. Broberg, MD⁎,†,⁎ (, )
- Masuo Ujita, MD‡,
- Sanjay Prasad, MD§,
- Wei Li, MD, PhD⁎,
- Michael Rubens, FRCR‡,
- Bridget E. Bax, PhD∥,
- Simon J. Davidson, FIBMS CSci¶,
- Beatriz Bouzas, MD⁎,
- J. Simon R. Gibbs, MD#,
- John Burman, MD¶ and
- Michael A. Gatzoulis, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Craig S. Broberg, UHN 62, Division of Cardiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239.
Objectives This study sought to determine what factors are associated with pulmonary artery thrombi in Eisenmenger patients.
Background Pulmonary artery thrombosis is common in Eisenmenger syndrome, although its underlying pathophysiology is poorly understood.
Methods Adult patients with Eisenmenger syndrome underwent computed tomography pulmonary angiography, cardiac magnetic resonance imaging, and echocardiography. Measurement of ventricular function, pulmonary artery size, and pulmonary artery blood flow were obtained. Hypercoagulability screening and platelet function assays were performed.
Results Of 55 consecutive patients, 11 (20%) had a detectable thrombus. These patients were older (p = 0.032), but did not differ in oxygen saturation, hemoglobin, or hematocrit from those without thrombus. Right ventricular ejection fraction by magnetic resonance imaging was lower in those with thrombus (0.41 ± 0.15 vs. 0.53 ± 0.13, p = 0.017), as was left ventricular ejection fraction (0.48 ± 0.12 vs. 0.60 ± 0.09, p = 0.002), a finding corroborated by tissue Doppler and increased brain natriuretic peptide. Those with thrombus also had a larger main pulmonary artery diameter (48 ± 14 mm vs. 38 ± 9 mm, p = 0.007) and a lower peak systolic velocity in the pulmonary artery (p = 0.003). There were no differences in clotting factors, platelet function, or bronchial arteries between groups. Logistic regression showed pulmonary artery velocity to be independently associated with thrombosis.
Conclusions Pulmonary arterial thrombosis among adults with Eisenmenger syndrome is common and relates to older age, biventricular dysfunction, and slow pulmonary artery blood flow rather than degree of cyanosis or coagulation abnormalities. Further work to define treatment efficacy is needed.
Supported by a grant from the Royal Brompton Hospital Clinical Research Committee. Salary support for Dr. Broberg was provided by the Waring Trust, Royal Brompton Hospital, and an unrestricted grant from Actelion, United Kingdom. Prof. Gatzoulis and the Royal Brompton Adult Congenital Heart Program have received support from the British Heart Foundation, London, England.
- Received January 3, 2007.
- Revision received April 10, 2007.
- Accepted April 15, 2007.
- American College of Cardiology Foundation