Intracardiac thrombus formation after the Fontan operation

Abstract

In patients having had a Fontan operation with inadequate or without anticoagulation medication, we would recommend routine transesophageal echocardiography to exclude eventual thrombi. Because of the high incidence of thrombi, we suggest oral anticoagulation therapy in all patients.

Echocardiography in Pregnancy: Part 1

“…Due to the increased venous flow in pregnancy and the fixed cardiac output of a Fontan circulation, women are at high risk of atrial arrhythmias and right-sided heart failure [11]. TEE has been recommended to rule out right atrial thrombi due to sluggish venous Fontan flow [36]. Pregnant women with Fontan circulation are considered high risk (WHO Class III), but pregnancy can be achieved safely depending on the physiology of the Fontan circuit [2••, 37, 38].…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…139,172,182 The reported incidence of thrombosis (5%-33%) varies by definition and diagnostic approach. 82,83,91,257,258 The embolic potential and intracardiac shunting in these patients leaves them at risk for acute shunt occlusion.…”

“…189 The prevalence of thrombosis as noted in crosssectional studies using transesophageal echocardiography ranges from 17% to 33%. 258 Retrospective reviews report varying risks of thrombosis and thrombosis-related events (both systemic venous thrombosis and primary stroke). The variance is dependent on many factors, particularly the duration of the observation period and whether the review was focused on thrombosis (3%-15% for thrombosis, 3%-9% for events) or on outcomes after Fontan in general (1%-7% for thrombosis, 1%-12% for events).…”

Management of the Fontan circulation in the adult patient

“…The non-pulsatile and often turbulent blood flow through the Fontan, predisposes the patient to thromboembolism, (17) which can have dire consequences. Even micro thrombi in the Fontan pathway can, in time, lead to an increase in the pulmonary vascular resistance and large thrombi can occlude the circuit with fatal consequences.…”