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Catheter-directed therapy for acute pulmonary embolism in children

Published online by Cambridge University Press:  21 December 2018

Jyothsna Akam-Venkata ,
Thomas J. Forbes ,
Theodore Schreiber ,
Amir Kaki ,
Mahir Elder ,
Daniel R. Turner  and
Daisuke Kobayashi
Jyothsna Akam-Venkata
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
Thomas J. Forbes
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
Theodore Schreiber
Affiliation:
Detroit Medical Center Heart Hospital, Wayne State University School of Medicine, Detroit, MI, USA
Amir Kaki
Affiliation:
Detroit Medical Center Heart Hospital, Wayne State University School of Medicine, Detroit, MI, USA
Mahir Elder
Affiliation:
Detroit Medical Center Heart Hospital, Wayne State University School of Medicine, Detroit, MI, USA
Daniel R. Turner
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
Daisuke Kobayashi*
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
*
Author for correspondence: D. Kobayashi, MD, Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201-2119, USA. Tel: +1-313-745-5481; Fax: +1-313-993-0894; E-mail: dkobayas@dmc.org
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Abstract

Background

Acute pulmonary embolism is a life-threatening condition and rarely occurs in children. In adults, catheter-directed therapy emerges as a potentially safer and effective therapeutic option. However, there is a paucity of data on the safety and efficacy of catheter-directed therapy for pulmonary embolism in children. We report a single-centred experience of catheter-directed therapy for acute pulmonary embolism in children.

Methods

This is a retrospective study of children who had no CHD and underwent catheter-directed therapy at Detroit Medical Center during a 12-year period from 2005 to 2017. Demographic and clinical data associated with pulmonary embolism were collected along with the outcome.

Results

A total of nine patients of median age 16 years with the range from 12 to 20 received catheter-directed therapy for sub-massive (n = 6) and massive pulmonary embolism (n = 3). Among nine patients, one patient received Angiojet thrombectomy and balloon angioplasty, whereas eight patients received catheter-directed thrombolysis using tissue plasminogen activator through infusion catheters (n = 3) or EkoSonic ultrasound-accelerated thrombolysis system (n = 5). In four out of five patients treated with EkoSonic, significant clinical improvement was noticed within 24 hours. Among seven patients who survived, two patients had minor gastrointestinal bleeding with median hospital stay of 8 days with the range from 5 to 24 days, and two patients with massive pulmonary embolism died possibly due to delayed institution of catheter-directed therapy.

Conclusion

Catheter-directed therapy with/without EkoSonic is an emerging alternative therapy for sub-massive and massive pulmonary embolism in children. A timely institution of catheter-directed therapy appeared important to improve the outcome.

Keywords

Pulmonary embolismchildrencatheter-directed therapyEkoSonic ultrasound-accelerated thrombolysis
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 263 - 269
Copyright
© Cambridge University Press 2018. 

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Footnotes

Cite this article: Akam-Venkata J, Forbes TJ, Schreiber T, Kaki A, Elder M, Turner DR, Kobayashi D. (2019) Catheter-directed therapy for acute pulmonary embolism in children. Cardiology in the Young29: 263–269. doi: 10.1017/S1047951118002135

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