THROMBOEMBOLIC COMPLICATIONS AFTER FONTAN OPERATIONS

被引:201
作者
ROSENTHAL, DN
FRIEDMAN, AH
KLEINMAN, CS
KOPF, GS
ROSENFELD, LE
HELLENBRAND, WE
机构
[1] YALE UNIV,SCH MED,DEPT PEDIAT,PEDIAT CARDIOL SECT,NEW HAVEN,CT 06510
[2] YALE UNIV,DEPT CARDIOTHORAC SURG,NEW HAVEN,CT
关键词
SURGERY; THROMBOSIS; EMBOLISM; FONTAN PROCEDURE; COMPLICATIONS;
D O I
10.1161/01.CIR.92.9.287
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Despite the increasing recognition of thromboembolic complications of the Fontan procedure, data characterizing such events are limited. The total cavopulmonary connection is believed to be less prone to this complication than other modifications of Fontan operations. We examined our experience with thromboembolism after Fontan operations to better characterize these events and their relation to the type of Fontan operation performed. Methods and Results We retrospectively identified 70 patients who underwent a Fontan operation between January 1978 and March 1994. Patients were divided into three groups: (1) total cavopulmonary connection, (2) atriopulmonary connection, and (3) conduit interposition. Fourteen patients (20%) developed a thromboembolic complication during a mean (+/-SD) follow-up of 5.2+/-4.7 years. The rate of thrombosis was similar in each group. The time from Fontan operation to thrombosis averaged 6.1+/-5.0 years. The overall rate of thromboembolic events was 3.9 per 100 patient-years. Twelve of the 14-thrombi were located within the venous circulation, 1 was in the left ventricle, and the location of 1 was undetermined. Six of the patients (43%) were asymptomatic, 3 (21%) presented with cerebrovascular events, and 5 (36%) presented with other symptoms. Thromboembolic events occurred from the perioperative period to 15 years after surgery. Conclusions Thromboembolic complications occur frequently after the Fontan operation and its modifications and are a cause of significant morbidity. The time of presentation varies greatly. The rate of thrombosis appears to be similar in all modifications of the Fontan operation.
引用
收藏
页码:287 / 293
页数:7
相关论文
共 25 条
[1]   THROMBOLYSIS WITH TISSUE-TYPE PLASMINOGEN-ACTIVATOR FOLLOWING CARDIAC-SURGERY IN CHILDREN [J].
ASANTEKORANG, A ;
SREERAM, N ;
MCKAY, R ;
ARNOLD, R .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 1992, 35 (03) :317-322
[2]   COAGULATION-FACTOR ABNORMALITIES AS POSSIBLE THROMBOTIC RISK-FACTORS AFTER FONTAN OPERATIONS [J].
CROMMEDIJKHUIS, AH ;
HENKENS, CMA ;
BIJLEVELD, CMA ;
HILLEGE, HL ;
BOM, VJJ ;
VANDERMEER, J .
LANCET, 1990, 336 (8723) :1087-1090
[3]   SPECIFIC SEQUELAE AFTER FONTAN OPERATION AT MIDTERM AND LONG-TERM FOLLOW-UP - ARRHYTHMIA, LIVER DYSFUNCTION, AND COAGULATION DISORDERS [J].
CROMMEDIJKHUIS, AH ;
HESS, J ;
HAHLEN, K ;
HENKENS, CMA ;
BINKBOELKENS, MTE ;
EYGELAAR, AA ;
BOS, E .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1993, 106 (06) :1126-1132
[4]   A 6 YEAR EXPERIENCE WITH THE ST-JUDE MEDICAL VALVE - HEMODYNAMIC PERFORMANCE, SURGICAL RESULTS, BIOCOMPATIBILITY AND FOLLOW-UP [J].
CZER, LSC ;
MATLOFF, J ;
CHAUX, A ;
DEROBERTIS, M ;
YOGANATHAN, A ;
GRAY, RJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1985, 6 (04) :904-912
[5]   THROMBOLYTIC THERAPY FOR SUPERIOR VENA-CAVAL THROMBOSIS FOLLOWING SUPERIOR VENA-CAVA PULMONARY-ARTERY ANASTOMOSIS [J].
DAJEE, H ;
DEUTSCH, LS ;
BENSON, LN ;
PERLOFF, JK ;
LAKS, H .
ANNALS OF THORACIC SURGERY, 1984, 38 (06) :637-639
[6]  
DELEVAL MR, 1988, J THORAC CARDIOV SUR, V96, P682
[7]  
DEVIVIE ER, 1986, J THORAC CARDIOV SUR, V91, P690
[8]   THROMBOSIS COMPLICATING BALLOON ANGIOPLASTY OF LEFT PULMONARY-ARTERY STENOSIS AFTER FONTAN PROCEDURE - SUCCESSFUL TREATMENT WITH INTRAVENOUS STREPTOKINASE [J].
DISESSA, TG ;
YEATMAN, LA ;
WILLIAMS, RG ;
LOIS, JF ;
FRIEDMAN, WF ;
LAKS, H .
AMERICAN JOURNAL OF CARDIOLOGY, 1985, 55 (05) :610-611
[9]   ATRIAL THROMBI AFTER THE FONTAN OPERATION [J].
DOBELL, ARC ;
TRUSLER, GA ;
SMALLHORN, JF ;
WILLIAMS, WG .
ANNALS OF THORACIC SURGERY, 1986, 42 (06) :664-667
[10]  
DOTY DB, 1981, J THORAC CARDIOV SUR, V81, P470