Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis)

Kaulitz, Renate; Ziemer, Gerhard; Rauch, Ralf; Girisch, M.; Bertram, Harald; Wessel, Armin; Hofbeck, Michael

doi:10.1016/j.jtcvs.2004.08.045

Cited by 85 publications

(64 citation statements)

References 23 publications

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“…186-189 Kaulitz et al 189 described an older cohort that underwent Fontan or Glenn procedures at a median of 66 months of age and were followed up for a median of 91 months. In this older cohort, which had all types of thrombotic and thromboembolic events, including stroke, risk factors had begun to emerge such as protein-losing enteropathy, ventricular dysfunction, prolonged immobilization, and cardiac arrhythmias, problems more common in children with CHD who survive into adolescence and young adulthood.…”

Section: Stroke After the Fontan Operationmentioning

confidence: 99%

“…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).…”

Section: Long-term Anticoagulation In the Patient With A Palliated Simentioning

confidence: 99%

“…Other similar studies with few events concluded that there was no benefit to antithrombotic therapy. 189,273,274 A protocol aimed at reducing risk factors for thrombosis that included postoperative aspirin as the sole antithrombotic agent showed no thrombotic events at midrange follow-up (mean follow-up, 40 months). 186 Monagle et al 275 recently reported the first multicenter, randomized trial in this area comparing aspirin (5 mg·kg…”

Section: Long-term Anticoagulation In the Patient With A Palliated Simentioning

confidence: 99%

See 2 more Smart Citations

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

269

245

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Section: Stroke After the Fontan Operationmentioning

confidence: 99%

Section: Long-term Anticoagulation In the Patient With A Palliated Simentioning

confidence: 99%

Section: Long-term Anticoagulation In the Patient With A Palliated Simentioning

confidence: 99%

See 1 more Smart Citation

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

269

245

View full text Add to dashboard Cite

“…The prevalence of thrombosis after Fontan palliation is reportedly 1-33%, with a high, immediate risk of thrombosis after surgery and an increased risk for Fontan patients surviving into adulthood (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The anticoagulation regimens for these patients vary (3,11).…”

Section: Introductionmentioning

confidence: 99%

The Risk of Thromboembolic Complications in Fontan Patients with Atrial Flutter/Fibrillation Treated with Electrical Cardioversion

2016

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“…Other complications such as thromboembolism and protein-losing enteropathy are also directly related to the atriopulmonary technique [4][5][6]10 and also when patients undergo surgery in adulthood 6 . These latter complications were less frequent in the cavopulmonary technique 8,9,11,12 , mainly when the extracardiac conduit 8 was used (Tab. 1).…”

mentioning

confidence: 99%

Operação de Fontan: reflexões da evolução e perspectivas atuais

Atik¹

2006

Arq. Bras. Cardiol.

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Fontan, congenital heart diseases, surgery.As the Fontan operation 1 became the most frequently performed surgery in Pediatric Cardiology for the functional correction of many congenital heart diseases with singleventricle physiology, it started to be considered in relation to the most suitable maneuvers to minimize the complications that still challenge its management in the long term.Although the incidence of such complications has decreased mainly as from 1988 with the introduction of the total cavopulmonary technique 2 , we can still observe the occurrence of morbidity elements whose rates are disturbing and affect the evolution of this method.Because of the dynamics imposed on the new anatomic situation with the cavopulmonary connection which eliminates the pulsatile function of the right ventricle and establishes the slow venous flow through the venae cavae to the pulmonary arterial tree, the occurrence of complications resulting from congestive, electrical and thromboembolic aspects is thus facilitated.The congestive aspects are characterized by increased venous pressure, hepatomegaly, protein-losing enteropathy due to lymphangiectasia, lower-extremity edema, and ascitis.The electrical aspects concern both the decrease in sinus automatism and supraventricular arrhythmias such as extrasystoles, fibrillation, and paroxysmal tachycardias.The thromboembolic aspects, which start in the venous system and in venous-arterial junctions and conduit connections, are also related to the occurrence of several coagulation disorders caused by factors resulting from liver congestion.Pathogenic factors of these adverse elements are related to preoperative anatomic and functional aspects and that is why a more accurate analysis of these aspects is mandatory at the moment of the surgical procedure.In this setting, it is well timed to recall and mention the factors considered optimal for the surgical indication, which are mainly: preserved ventricular function close to normal, adequate pulmonary arterial tree with mean pressures below 15 mmHg and pulmonary resistance lower than 2U Wood, and also the presence of sinus rhythm responsive to stimuli 3 . Absence of atrioventricular and aortic regurgitation, of fistulae and systemic-pulmonary anastomotic vessels, in addition to myocardial hypertrophy are also included.These deleterious factors are effectively responsible for the mortality that occurs throughout time and which ranges, according to the expertise of each medical center, from 15 to 30% 15 years after the surgical procedure 3 . That is where death results from, mainly related to heart failure, arrhythmias, thromboembolism, and to protein-losing syndrome.Among the complications, those with the highest prevalence and repercussion are heart failure and arrhythmias, mainly in atriopulmonary 4-6 techniques, but also in cavopulmonary 7 procedures when performed in adulthood. These complications are less frequent in cavopulmonary connections with extracardiac conduits 8 than in intra-atrial lateral tunnel 7,9 . Other complica...

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Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis)

Cited by 85 publications

References 23 publications

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

The Risk of Thromboembolic Complications in Fontan Patients with Atrial Flutter/Fibrillation Treated with Electrical Cardioversion

Operação de Fontan: reflexões da evolução e perspectivas atuais

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