Abstract 13890: Post-Thrombotic Syndrome in Children with Congenital Heart Disease is Prevalent and Associated with Important Clinical Consequences
Post-thrombotic syndrome (PTS) is increasingly recognized as an important complication of deep venous thrombosis (DVT). Prevalence and relevance for children with congenital heart disease (CHD) has not yet been established. PTS is diagnosed with the modified Villalta scale (MVS), an adult scale adapted for children but incompletely validated in the context of CHD. N=101 children were assessed for PTS using the MVS, 38 had repaired CHD without DVT, 32 had repaired CHD with DVT (26 received anticoagulation) and 31 siblings with unremarkable medical history. All patients were >2 years old (average 6 years) at assessment (6m-5y post-repair). Assessors were blinded to the subjects' medical history. Patients with positive MVS screen had ultrasound (US) to confirm DVT. A random subset of patients were selected for inter/intra-reliability assessment of MVS. All patients underwent neurodevelopmental testing or functional health status assessment. Positive MVS was noted in 13/32 (41%) of CHD patients with previous DVT (all US confirmed), 7/38 (18%) of CHD patients without such history (1 US confirmed) and 2/31 (6%) control subjects. One patient with a known PTS diagnosis had a negative MVS. MVS scale performed well as a screening tool (negative prediction 98%) but poorly as a diagnostic tool (positive prediction 70%). Agreement between MVS and clinical diagnosis was highest for objective clinical findings (K>0.50) and lowest for pain scores (K<0.15). Inter and intra-observer reliability were moderately high (K=0.60). Compared to patients with CHD without PTS, patients with PTS were more likely to have delayed developmental milestones (Age/Stage Questionnaire) for communication (62% vs 23% p=0.02), gross motor skills (54% vs 28% p=0.10) and problem solving (54% vs 13% p=0.008). Functional health status scores were not different between the 2 groups. Patients with CHD are at high-risk for PTS, a clinical entity which remains under-characterized. MVS is currently insufficient to replace serial US in the monitoring of residual clots. MVS modifications, specific to this population, might be warranted. Future studies should focus on the clinicopathological processes of PTS in these patients and on defining long-term outcomes and screening strategies.
- © 2011 by American Heart Association, Inc.