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Intracardiac thrombus formation after the Fontan operation
G Balling1, M Vogt, H Kaemmerer
1Departments of Pediatric Cardiology and Congenital Heart Disease and Cardiac Surgery, German Heart Center, Technical University, Munich, Germany. Balling@DHM.mhn.de
The Journal of Thoracic and Cardiovascular Surgery
|March 25, 2000
Summary
Intracardiac thrombi occur in one-third of Fontan operation patients, often without symptoms. Researchers found no specific risk factors, suggesting routine screening and anticoagulation for all Fontan survivors.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thrombosis Research
Background:
- Intracardiac thrombus formation is a suspected complication after the Fontan operation.
- Transthoracic echocardiography has limitations in detecting these thrombi.
Purpose of the Study:
- To evaluate the occurrence of intracardiac thrombi in various Fontan modifications.
- To identify potential predisposing risk factors for thrombus formation.
Main Methods:
- Transesophageal echocardiography was used to assess 52 asymptomatic patients post-Fontan operation.
- Analysis included underlying disease, age, operation type, sex, follow-up, arrhythmias, and lab/hemodynamic data.
Main Results:
- Thrombi were detected in 17 (33%) patients, despite the absence of clinical thromboembolic events.
- No specific risk factors (e.g., disease type, age, operation type, sex, follow-up duration, arrhythmias, laboratory values, or hemodynamics) were identified.
Conclusions:
- Routine transesophageal echocardiography is recommended for Fontan patients, especially those with inadequate or no anticoagulation.
- Given the high incidence, oral anticoagulation therapy is suggested for all Fontan survivors to prevent thrombus formation.