Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-06-11T19:07:03.218Z Has data issue: false hasContentIssue false
  • English
  • Français

Formation of thrombus and thromboembolism after the bidirectional Glenn anastomosis, total cavopulmonary connection and the Fontan operation

Published online by Cambridge University Press:  19 August 2008

Katarina Hanséus ,
Gudrun Björkhem ,
Peeter Jögi  and
Sven-Erik Sonesson
Katarina Hanséus*
Affiliation:
The Divisions of Paediatric Cardiology and Paediatric Cardiac Surgery at the University Hospital of LundStockholm, Sweden
Gudrun Björkhem
Affiliation:
The Divisions of Paediatric Cardiology and Paediatric Cardiac Surgery at the University Hospital of LundStockholm, Sweden
Peeter Jögi
Affiliation:
The Divisions of Paediatric Cardiology and Paediatric Cardiac Surgery at the University Hospital of LundStockholm, Sweden
Sven-Erik Sonesson
Affiliation:
Division of Paediatric CardiologySt. Göran's Children's Hospital, Karolinska Institute, Stockholm, Sweden
*
Katarina Hanséus, Paediatric Clinic, University Hospital, S-221 85 Lund, phone 46-46-171110, fax 46-46-172307
Get access Rights & Permissions [Opens in a new window]

Abstract

Although patients undergoing surgery with the Fontan procedure or its modifications are increasingly recognised to be at risk for thromboembolism, further knowledge is needed to minimise this complication and its sequels. To address this issue, we reviewed 100 patients operated with the Fontan procedure, the bidirectional Glenn anastomosis and/or the total cavopulmonary connection to describe our incidence and clinical characteristics of postoperative formation of thrombus. Symptomatic thrombosis or cerebrovascular accidents were found in 5 patients. Asymptomatic thrombus were found in another 5 patients. Three patients had venous thrombi. In 6 patients the thrombosis was found on the arterial side. In all these cases, the thrombus was located in the stump of the divided pulmonary trunk. In 3 of these patients, sudden onset of hemiparesis preceded the diagnosis of the thrombus while the remaining 3 patients were asymptomatic. In 3 cases, the formation of thrombus in the stump of the divided pulmonary trunk occurred after a bidirectional Glenn anastomosis. One patient developed severe neurological symptoms 2 months after a total cavopulmonary connection. No thrombus was found, but the patient had a small right-to-left shunt and embolization could not be excluded. The incidence of thrombosis after Fontan-type surgery in this study is 10%. Although not all episodes of thrombosis are symptomatic, there is a significant risk of severe sequels due to embolization to the pulmonary or cerebral circulations. The stump of the divided pulmonary trunk is one of the main sites for intracardiac formation of thrombus, even after a bidirectional Glenn anastomosis.

Keywords

Tricuspid atresiadouble inlet ventriclefunctional univentricular circulation
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 2 , April 1998 , pp. 211 - 216
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cromrne-Dijkhuis, AH, Henkens, CMA, Biljleveld, CMA, Hillege, HL, Born, VJJ, v der Meer, J.Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operation. Lancet 1990 336: 1087–1090CrossRefGoogle Scholar
2.Day, RW, Boyer, RS, Tait, VF, Ruttenberg, HD.Factors associated with stroke following the Fontan procedure. Pediatr Cardiol 1995 16: 270–275, 1995CrossRefGoogle ScholarPubMed
3.Dobell, ARC, Trusler, GA, Smallhorn, JF, Williams, WG.Atrial thrombi after the Fontan operation. Ann Thorac Surg 1986 42: 664–667CrossRefGoogle ScholarPubMed
4.Jahangiri, M, Ross, DB, Redington, AN, Lincoln, C, Shinebourne, EA.Thromboembolism efter the Fontan procedure and its modifications. Ann Thorac Surg 1994 58: 1409–1414CrossRefGoogle Scholar
5.Hedrick, M, Elkins, RC, Knott-Craig, J, Razook, JD.Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature J Thorac Cardiovasc Surg 1993 105 (2): 297–301CrossRefGoogle ScholarPubMed
6.Rosenthal, DN, Friedman, AH, Kleinman, CS, Kopf, GS, Rosenfeld, LE, Hellenbrand, WE.Thromboembolic complications after Fontan operations. Circ 1995 92(suppl II):287–293CrossRefGoogle ScholarPubMed
7.Jonas, RA. Editorial: Intracardiac thrombus after the Fontan procedure. J Thorac and Cardiovasc Surg 1995 110 (5): 1502–1503CrossRefGoogle ScholarPubMed
8.Rosenthal, DN, Bulbul, ZR, Friedman, AH, Hellenbrand, WE, Kleinman, CS.Thrombosis of the pulmonary artery after distal ligation. J Thorac and Cardiovasc Surg 1995 110 (5): 1563–1565CrossRefGoogle ScholarPubMed
9.duPlessis, AJ, Chang, AC, Wessel, DL, Lock, JE, Wernovsky, G, Newburger, JW, Mayer, JL.Cerebrovascular accidents following the Fontan operation. Ped Neurol 1995 12:230–236CrossRefGoogle Scholar
10.Lam, J, Neirotti, R, Becker, AE, Planche, C.Thrombosis after the Fontan procedure: Transesophageal echocardiography may replace angiocardiography. J Thorac Cardiovasc Surg 1994 108 (1):194–195CrossRefGoogle ScholarPubMed
11.Mair, DD, Rice, MJ, Hagler, DJ, Puga, FJ, McGoon, DC, Danielson, GK.Outcome of the Fontan procedure in patients with tricuspid atresia Circ 1985 72 (suppl II) 11–88Google ScholarPubMed
12.Putnam, JB, Lemmer, JH, Rocchini, AP, Bove, EL.Embolectomy for acute pulmonary artery occlusion following Fontan procedure Ann Thorac Surg 1988 45: 335–336CrossRefGoogle ScholarPubMed
13.Hutto, RL, Williams, JP, Maertens, P, Wilder, WM, Williams, RS. Cerebellar infarct: late complication of the Fontan procedure? Pediatr Neurol 1991 (7): 293–295CrossRefGoogle Scholar
14.Mathews, K, Bale, JF, Clark, EB, Marwin, WJ, Doty, DB.Cerebral infarction complicating Fontan surgery for cyanotic congenital heart disease Pediatr Cardiol 1986 7: 161–166CrossRefGoogle ScholarPubMed
15.Sanders, SP, Wright, GB, Keane, JF, Norwood, WI, Castaneda, AR.Clinical and hemodynamic results of the Fontan procedure for tricuspid atresia Am J Cardiol 1982 49: 1733–1740CrossRefGoogle Scholar
16.Wilson, DG, Wisheart, JD, Stuart, AG.Systemic thromboembolism leading to myocardial infarction and stroke after fenestrated cavopulmonary connexion Br Heart J 1995 73: 483–485CrossRefGoogle Scholar
17.Fyfe, DA, Kline, CH, Sade, RM, Gillette, PC.Transesophageal echocardiography detects thrombus formation not identified by rransthoracic echocardiography after the Fontan operation. J Am Colt Cardiol 1991 18: 1733–1737CrossRefGoogle Scholar
18.Okira, Y, Miki, S, Kusuhara, K, Ueda, Y, Tahata, T, Komeda, K, Tamura, T.Massive systemic venous thrombosis after Fontan operation. A report of a case. Thorac Cardiovasc 1988 Surg 36: 234–236Google Scholar
19.Stümper, O, Sutherland, GR, Geuskens, R, Roelandt, JR, Bos, E, Hess, J.Transesophageal echocardiography in evaluation and management after a Fontan procedure. J Am Coll Cardiol 1991 17: 1152–1160CrossRefGoogle ScholarPubMed
20.Danielson, GKInvited commentary to Jahangiri et.al. Ann Thorac Surg 1994 199458: 1409–1414CrossRefGoogle Scholar
21.Turner-Gomes, SO, Andrew, M, Coles, J, Trusler, GA, Williams, WG, Rabinovitch, M.Abnormalities in von Willebrand factor and antithrombin III after cardiopulmonary bypass operations for congenital heart disease. J Thorac Cardiovasc Surg 1992 103: 87–97CrossRefGoogle ScholarPubMed
22.Cromme-Dijkhuis, AH, Hess, J, Hählen, K, Henkens, CMA,Bink-Boelkens, E, Eygelaar, AA, Bos, E.Specific sequelae after Fontan operation at mid- and long-term follow-up. Arrhythmia, liver dysfunction and coagulation disorders. J Thorac Cardiovasc Surg 1993 106: 1126–1132CrossRefGoogle ScholarPubMed
23.Jahangiri, M, Shore, D, Kakkar, V, Lincoln, C, Shinebourne, ES.Anticoagulation defects following Fontan. Card Young 1996 suppl 6: 28Google Scholar
24.Kaulitz, R, Luhmer, I, Bergmann, F, Kallfelz, HC.Morbidity after modified Fontan operation - necessity of detailed clinical and laboratory evaluation. Card Young 1996 suppl 6: 19Google Scholar