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Thromboembolism after the Fontan procedure and its modifications
M Jahangiri1, D B Ross, A N Redington
1Department of Paediatric Cardiology, Royal Brompton National Heart and Lung Hospital, London, England.
The Annals of Thoracic Surgery
|November 1, 1994
Summary
Thromboembolism is a common complication following the Fontan procedure, occurring months to years later. Long-term anticoagulant therapy is recommended for all patients after this surgery.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Surgery
Background:
- The Fontan procedure is a palliative surgery for complex congenital heart disease.
- Thromboembolic complications after the Fontan procedure are not well-characterized.
Purpose of the Study:
- To determine the frequency and timing of thromboembolism after the Fontan procedure.
- To assess the impact of thromboembolism on morbidity and mortality.
Main Methods:
- Retrospective review of 64 patients who underwent the Fontan procedure between 1987 and 1992.
- Analysis of postoperative anticoagulation duration and identification of thromboembolic events during follow-up (6-55 months).
Main Results:
- Ten cases of thromboembolism were identified, occurring between 7 days and 4.5 years post-Fontan repair.
- Thrombi were found in both venous (7 cases) and arterial (3 cases) circulations.
- Freedom from thromboembolism was 75% at 4 years post-procedure.
Conclusions:
- Thromboembolism is a significant and common complication after the Fontan procedure.
- These events contribute to late morbidity and mortality.
- Long-term anticoagulation is suggested for all patients following Fontan repair.