ECG AND ECHOCARDIOGRAPHIC DIAGNOSIS OF PULMONARY THROMBOEMBOLISM ASSOCIATED WITH CENTRAL VENOUS LINES

The aim was to establish the prevalence of pulmonary embolism in 21 ch ildren (median age 12 months; range 5-132 months) with central venous lines in situ >3 months (median 10 months; range 3-47). Twelve-lead el ectrocardiograms (ECGs) and echocardiograms were analysed in a retrosp ective study using ECG and echocardiographic criteria for pulmonary em bolism - previously established and validated in adult patients - and standard paediatric ECG values as control data. Patients were scored a s having definite (n = 7), probable (n = 5), or no pulmonary embolism (n = 9). Overall 57% of ECGs showed abnormalities compatible with pulm onary embolism. In two patients, serial ECGs obtained during an acute cardiorespiratory illness showed cumulative changes diagnostic of pulm onary embolism. Eight of 12 patients with abnormal ECGs had echocardio graphy; in seven of these (88%) the right ventricular end diastolic di ameter was >2SD above the mean value for age. Twelve of the patients i ncluded in this study have died; two died following an acute respirato ry illness. There was postmortem evidence of pulmonary thromboembolism in both of the two children for whom necropsy information was availab le. The data suggest that pulmonary embolism is common in children who have central venous lines in situ for >3 months. Serial studies are o f value in some patients. Pulmonary embolism may compromise the long t erm survival of children with small bowel failure and preclude conside ration for liver and small bowel transplantation.