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Related Experiment Videos

Thromboembolic complications after Fontan operations

D N Rosenthal1, A H Friedman, C S Kleinman

  • 1Department of Pediatrics, Yale University, New Haven, CT 06510, USA.

Circulation
|November 1, 1995
PubMed
Summary

Thromboembolic complications are frequent after the Fontan procedure, occurring in 20% of patients. These events, including venous thrombosis, happen years after surgery and affect all Fontan modifications similarly.

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiovascular Surgery

Background:

  • Thromboembolic complications are a recognized risk following the Fontan procedure.
  • Limited data exists characterizing these events, particularly in relation to different Fontan modifications.
  • The total cavopulmonary connection is hypothesized to have a lower risk compared to other Fontan types.

Purpose of the Study:

  • To characterize thromboembolic events after Fontan operations.
  • To investigate the relationship between the type of Fontan operation and the occurrence of thromboembolism.
  • To assess the incidence, timing, and presentation of thromboembolic complications.

Main Methods:

  • Retrospective review of 70 patients who underwent a Fontan operation between 1978 and 1994.

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  • Patients were categorized into three groups: total cavopulmonary connection, atriopulmonary connection, and conduit interposition.
  • Follow-up data was analyzed for the development of thromboembolic complications.

    • Main Results:

    • 14 patients (20%) experienced thromboembolic complications over a mean follow-up of 5.2 years.
    • The rate of thrombosis was similar across all three Fontan modifications.
    • Events occurred up to 15 years post-surgery, with a mean time to thrombosis of 6.1 years; 43% were asymptomatic.

    Conclusions:

    • Thromboembolic complications are a common and significant cause of morbidity after Fontan operations and their modifications.
    • The timing of these complications is highly variable, ranging from the perioperative period to many years later.
    • Current Fontan modifications do not appear to significantly alter the rate of thrombosis.