{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T13:12:18Z","timestamp":1769173938571,"version":"3.49.0"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T00:00:00Z","timestamp":1477008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR000003"],"award-info":[{"award-number":["UL1TR000003"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>\u2018Paradoxical\u2019 embolization via intracardiac or intrapulmonary right\u2010to\u2010left shunts (<jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content>) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (<jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>), predispose to paradoxical embolization. We hypothesized that children with <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content> and overt stroke (<jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\u00a0+\u00a0stroke) have an increased prevalence of potential <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content>. We performed contrasted transthoracic echocardiograms on 147 children (aged 2\u201319\u00a0years) with <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\u00a0+\u00a0stroke) mean age 12\u00b77\u00a0\u00b1\u00a04\u00b78\u00a0years, 54\u00b74% male) and a control group without <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content> or stroke (<jats:italic>n<\/jats:italic>\u00a0=\u00a0123; mean age 12\u00b71\u00a0\u00b1\u00a04\u00b79\u00a0years, 53\u00b73% male). <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> was defined as any potential <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> was significantly higher in the <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>+stroke group than controls (45\u00b76% vs. 23\u00b76%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b7001). The odds ratio for potential <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> in the <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\u00a0+\u00a0stroke group was 2\u00b77 (95% confidence interval: 1\u00b76\u20134\u00b76) vs controls. In <jats:italic>post hoc<\/jats:italic> analyses, the <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>\u00a0+\u00a0stroke group had a higher prevalence of intrapulmonary (23\u00b78% vs. 5\u00b77%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b7001) but not intracardiac shunting (21\u00b78% vs. 18\u00b77%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b7533). <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content> patients with potential <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/bjh.14391","type":"journal-article","created":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T07:43:00Z","timestamp":1477035780000},"page":"300-308","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Increased prevalence of potential right\u2010to\u2010left shunting in children with sickle cell anaemia and stroke"],"prefix":"10.1111","volume":"176","author":[{"given":"Michael M.","family":"Dowling","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and Neurology &amp; Neurotherapeutics UT Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles T.","family":"Quinn","sequence":"additional","affiliation":[{"name":"Division of Hematology Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Ramaciotti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics UT Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Kanter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Medical University of South Carolina Charleston SC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ifeyinwa","family":"Osunkwo","sequence":"additional","affiliation":[{"name":"The Levine Cancer Institute Carolinas HealthCare System Charlotte NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baba","family":"Inusa","sequence":"additional","affiliation":[{"name":"Haematology Evelina Children's Hospital Guy's and St. Thomas NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rathi","family":"Iyer","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center Jackson MS USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet L.","family":"Kwiatkowski","sequence":"additional","affiliation":[{"name":"Division of Hematology Children's Hospital of Philadelphia and Department of Pediatrics University of Pennsylvania Perelman School of Medicine Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarissa","family":"Johnson","sequence":"additional","affiliation":[{"name":"Cook Children's Health Care System Ft. 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