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Postoperative graft thrombosis in Fontan procedure
A Sarigül1, B Farsak, I Koramaz
1Department of Thoracic and Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Fontan repair is a palliative surgery for complex heart disease. Thrombosis after this surgery can be treated with a redo Fontan operation, and prophylactic anticoagulation may reduce risks.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Fontan repair is a palliative surgical procedure for complex cyanotic congenital heart disease.
- Modified Fontan operations, specifically the right atrium-right ventricular connection with a conduit, can be complicated by thrombosis.
Observation:
- Two patients who previously underwent a Bjork modification Fontan operation developed thrombosis 6 and 9 years post-surgery.
- Thrombosis occurred in the right side of the heart in both cases.
Findings:
- Redo Fontan operations were successfully performed in both patients using a dacron tube graft.
- Post-operative anticoagulation was administered to both patients.
Implications:
- Redo Fontan operations are a viable treatment for post-Fontan thrombosis.
- Prophylactic anticoagulation in high-risk patients soon after Fontan repair may minimize the risk of thrombosis.
Abstract:
Fontan repair could be used as the definitive palliation in many forms of complex cyanotic congenital heart disease. But thrombosis can occur after a modified Fontan operation (right atrium-right ventricular connection with a conduit). Appropriate management of this complication includes thrombolytic therapy, thrombectomy and revision (if surgically remediable causes of the thrombosis are identified) or redo operation. Two repair operations were performed for the treatment of thrombosis of the right side of the heart in patients in whom we had previously performed Bjork modification (right atrium-right ventricular connection with a conduit). The thromboses occurred 6 and 9 years after the operation, respectively. In both cases, the redo Fontan operation was successfully performed using a dacron tube graft. Patients were anticoagulated after the operation. Risk of thrombosis of the right side of the heart after the Fontan repair may be minimized with the use of prophylactic anticoagulation in high-risk patients soon after the operation.