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Thrombus formation after the Fontan operation
P D Coon1, J Rychik, R T Novello
1Cardiac Center at the Children's Hospital of Philadelphia, PA 19104, USA.
Insights
Thrombus formation after Fontan operation is common and occurs equally across different surgical modifications. This suggests thrombus development is inherent to the Fontan physiology, not the specific surgical approach.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- Thrombus formation is a frequent complication following the Fontan operation.
- Understanding thrombus prevalence and location is crucial for patient management.
Purpose of the Study:
- To investigate the frequency and anatomical location of intracardiac thrombus in children post-Fontan operation.
- To determine if thrombus formation varies based on the type of Fontan surgical modification.
Main Methods:
- Retrospective analysis of 592 patients undergoing echocardiography after Fontan operation (1987-1999).
- Evaluation of thrombus presence, location, and correlation with surgical type (atriopulmonary vs. lateral tunnel) and fenestration.
Main Results:
- Intracardiac thrombus was identified in 8.8% of patients.
- Thrombus locations included systemic venous atrium (48%), pulmonary venous atrium (44%), and others.
- No significant difference in thrombus freedom was observed based on surgical type or fenestration.
Conclusions:
- Thrombus formation after Fontan operation occurs with similar frequency across different surgical modifications.
- The findings suggest thrombus development is an intrinsic aspect of Fontan physiology, irrespective of surgical technique.
Background:
Thrombus formation is common after a Fontan operation. We investigated the frequency and location of thrombus in our population of children based on the type of Fontan operation performed.
Methods And Results:
Between January 1987 and January 1999, 592 patients underwent echocardiography after Fontan operation and 52 (8.8%) had intracardiac thrombus. Median age at Fontan operation was 1.9 years (range 0.8 to 35.1). Freedom from thrombus was 92%, 90%, 84% and 82% at 1, 3, 8, and 10 years after Fontan operation, respectively. There was no difference in freedom from thrombus, based on type of operation (atriopulmonary vs. lateral tunnel) or presence of fenestration. Thrombus was detected in the systemic venous atrium in 26 (48%), in the pulmonary venous atrium in 22 (44%), in both atria in 1 (2%), in the hypoplastic left ventricular cavity in 2 (8%), and in the ligated pulmonary artery stump in 1 (2%).
Conclusions:
Thrombus formation occurs with equal frequency in all types of modifications and is seen in the pulmonary, as well as the systemic venous atria. Our study suggests that thrombus formation is inherent to the physiology after Fontan operation and is not related to the type of modification performed.