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Systemic thromboembolism leading to myocardial infarction and stroke after fenestrated total cavopulmonary connection
D G Wilson1, J D Wisheart, A G Stuart
1Congenital Heart Disease Research Unit, University Hospital of Wales, Heath Park, Cardiff.
Insights
Systemic thromboembolism is a rare complication after Fontan-type operations. Lifelong anticoagulation may prevent thrombotic events, outweighing bleeding risks in pediatric cardiac surgery patients.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Thrombosis Research
Background:
- Thromboembolic events are known complications following Fontan operations and total cavopulmonary connections.
- These events can involve the caval veins, right atrium, and pulmonary artery.
- A rare case of systemic thromboembolism in a child post-fenestrated total cavopulmonary shunt highlights the need for further investigation.
Abstract:
Thromboembolic phenomena involving the caval veins, right atrium, and pulmonary artery are recognised complications after the Fontan operation and other forms of total cavopulmonary connection. A rare case of systemic thromboembolism is reported in a 3 year old girl who had repeated coronary and cerebral thromboembolic events after a fenestrated total cavopulmonary shunt operation. A survey of the 18 paediatric cardiac units in the United Kingdom and Ireland showed a wide discrepancy in anticoagulation policies after Fontan-type operations. Prevention of thrombotic complications by lifelong postoperative anticoagulation may outweigh the risk of haemorrhage.