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Common Congenital Heart Lesions - page 121 / 126





121 / 126

121 of 126

Diagnostic tests/Imaging:

  • Serum D-dimer: byproduct of fibrin degradation that can be measured from peripheral blood; using enzyme- linked immunoassay, D-dimer assay is highly sensitive for diagnosis of DVT (and/or acute pulmonary embolism).

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      D-dimer also elevated in cancer, inflammation, infection, necrosis – positive test is, thus, not specific for DVT.

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        Normal D-dimer value helps exclude DVT; elevated level does not confirm DVT.

  • Venous compression duplex ultrasonography: available, noninvasive test that is 97% sensitive and 97% specific for diagnosis of symptomatic DVT in a proximal vein (not as good for a calf vein).

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        Vein is imaged with real-time US and pulsed by Doppler US to assess blood flow

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        To diagnose, must have: inability to compress vein w/ direct pressure, direct visualization of thrombus, absence

of blood flow in the vein.

  • Magnetic resonance venography: less frequently used – aids in diagnosis of proximal, particularly pelvic, DVT

  • Contrast venography: less frequently used – invasive imaging technique that can provide definitive diagnosis


  • Treat patients in order to prevent pulmonary embolism (PE).

  • Elevate the affected extremity above level of heart to reduce edema and tenderness.

  • Anticoagulation to prevent extension of thrombus.

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      First, use sub-cutaneous LMW Heparin (I.V. unfractionated heparin is more cost-effective)

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        Long term, use warfarin (advantage in that it is oral)

  • Catheter-based thrombolysis: seldom used – but is for patients with ileofemoral DVT

  • Intravascular filter in IVC: only used for patients who can’t take anticoagulants due to a bleeding disorder

  • Treatment for calf vein thrombosis is controversial – may not need to treat as is less likely to get PEs from calf.

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      Monitor patient to determine if thrombus propagates into proximal veins…then treat.

  • DVT Prophylaxis is mandatory when risk of DVT is high (i.e. when have bed rest after surgery): prophylax with

one of the heparins, with low-dose warfarin, with compression stockings, or with pneumatic compression of legs

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