Biventricular Thrombi in a Patient With Heart Failure With Severely Reduced Ejection Fraction and Heterozygous Prothrombin 20210G/A and Homozygous Methylenetetrahydrofolate Reductase 677C/T Mutations.

Thrombus in the heart is known to be one of the many sequelae of anterior wall myocardial infarction, atrial fibrillation and coagulation disorders. However, biventricular thrombi are relatively rarely found, even in conditions with a high possibility of thrombus formation. We report the case of a 75-year-old-woman with newly diagnosed systolic heart failure secondary to a nonischemic cardiomyopathy, who was found to have large biventricular thrombi. Further coagulopathy work-up revealed that she was heterozygous for the prothrombin 20210G/A and homozygous for the methylenetetrahydrofolate reductase (MTHFR) 677C/T mutations. We, herein, review and discuss previous case reports and published literature regarding ventricular thrombosis and its treatment. To the best of our knowledge, this is the first case of biventricular thrombosis with prothrombin 20210G/A and MTHFR 677C/T mutations.

The decanalization of weight, recumbent length, and head circumference during infancy.

This study has estimated the extent to which 659 infants in the Fels Longitudinal Study maintained their positions in canals on the current NCHS growth charts during 6- and 12-month intervals. These canals are the zones between adjacent major percentile lines (5th, 10th, 25th, 50th, 75th, 90th, and 95th) on the growth charts. The probabilities of increases or decreases in level by two or more canals were calculated. Additionally, the probabilities were calculated for changes in level from between the 5th and 10th percentiles or between the 90th and 95th percentiles to zones beyond the 5th or 95th percentiles, respectively (transitions from normal limits). The analyses were made from birth to 36 months for weight and from 1-36 months for length and head circumference. The probabilities of decanalization were larger for weight than for length or head circumference for the interval from birth to 6 months, but not later. The probabilities for each variable analyzed tended to be large for young age intervals and larger for changes toward the medians than for changes from the medians. The directions of decanalization for weight from birth to 6 months were related to birth weight and those for length were related to midparent stature for the intervals from 6-12 months in each sex, 1-12 months in girls, and 6-18 months in boys. Am. J. Hum. Biol. 9:689-698, 1997. © 1997 Wiley-Liss, Inc.

Decanalization of weight and stature during childhood and adolescence.

The probabilities that children and adolescents alter their positions to non-adjacent canals (decanalization) on the current NCHS growth charts have been estimated. In this context, canals are the zones between the major percentile levels (5th, 10th, 25th, 50th, 75th, 90th, and 95th) that are shown on the charts. These probabilities were calculated for one- and 2-year intervals, beginning at each annual age from 3-16 years, using serial data for weight and stature from 329 male and 303 female participants in the Fels Longitudinal Study. The probabilities of particular types of decanalizations, categorized by the initial canal and the direction of the change in relative level (decrease/loss; increase/gain) are presented. The probabilities for 1-year intervals were very low and, therefore, they are not presented. Additionally, probabilities were calculated for transitions from the canal between the 5th and 10th percentiles to the zone below the 5th percentile and from the canal between the 90th and 95th percentiles to the zone above the 95th percentile. Both these transitions are shifts to levels that are outside the normal range, and are more common than decanalization. The probabilities of decanalization and of transitions from the normal range were generally larger for weight than for stature except for transitions from the canal between the 90th and 95th percentiles to the zone beyond the 95th percentile. The probabilities for both weight and stature tended to be larger for changes toward the medians than for changes from the medians. Decanalizations that involved increases in level were significantly related to advanced skeletal maturation at ages younger than the usual age of peak height velocity and to retarded skeletal maturation at ages older than the usual age of peak height velocity. Am. J. Hum. Biol. 10:351-359, 1998. © 1998 Wiley-Liss, Inc.