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Coagulation profile, hepatic function, and hemodynamics following Fontan-type operations.

H Tomita¹, O Yamada, H Ohuchi

¹Department of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan. tomitah@hsp.ncvc.go.jp

Cardiology in the Young

|March 10, 2001

Summary

The Fontan procedure impacts coagulation and liver function, with altered protein synthesis potentially increasing risks for bleeding and thrombosis. Abnormal hemodynamics may lead to hepatic dysfunction post-surgery.

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Area of Science:

Cardiology
Hepatology
Hematology

Background:

The Fontan procedure is a complex surgical intervention for single-ventricle physiology.
Understanding post-operative physiological changes is crucial for patient management.

Purpose of the Study:

To investigate the relationship between coagulation profiles, hepatic function, and hemodynamics in Fontan procedure patients.
To compare these parameters with control groups.

Main Methods:

Retrospective analysis of 30 patients who underwent a Fontan-type procedure.
Comparison with a control group (n=12) and a high right atrial pressure group (n=14).
Analysis included coagulation tests, liver function tests, and hemodynamic measurements via catheterization.

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Main Results:

Fontan patients showed significantly lower prothrombin time and factor XIII levels.
Lower protein C and plasminogen levels were observed in Fontan patients compared to controls and high-pressure groups.
Elevated liver enzymes (AST, ALT, GGT) and highest mean right atrial pressure were noted in Fontan patients, with the lowest cardiac index.
Significant correlations were found between coagulation factors, liver enzymes, mean right atrial pressure, and cardiac index.

Conclusions:

Fontan procedure is associated with decreased synthesis of pro- and anti-coagulant factors, increasing risks of thrombosis and bleeding.
Abnormal hemodynamics in Fontan patients may cause subclinical hepatic dysfunction, affecting protein synthesis.