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Atrial thrombus after the Fontan-operation: predisposing factors, treatment and prophylaxis

Published online by Cambridge University Press:  19 August 2008

R. Kaulitz ,
G. Ziemer ,
F. Bergmann ,
I. Luhmer  and
H. C. Kallfelz
R. Kaulitz*
Affiliation:
Division of Pediatric Cardiology; Medical School, Hanover, Germany
G. Ziemer
Affiliation:
Division of Thoracic and Cardiovascular Surgery; Medical School, Hanover, Germany
F. Bergmann
Affiliation:
Division of Pediatric Cardiology; Medical School, Hanover, Germany
I. Luhmer
Affiliation:
Division of Pediatric Cardiology; Medical School, Hanover, Germany
H. C. Kallfelz
Affiliation:
Division of Pediatric Cardiology; Medical School, Hanover, Germany
*
Renate Kaulitz, M.D. Div. of Pediatric Cardiology, Medical School Hannover, 30625 Hannover, Germany. Tel: 49 511 532 3220, Fax: 49 511 532 9038
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Abstract

Thrombosis of the right side of the heart has previously been a rarely reported early or late postoperetive complication after a modified Fontan-procedure.

In 4(5.5%) of 72 surviving patients who underwent a total cavopulmonary connection for various forms of univentricular atrioventricular connection or other complex lesion a thrombus within the right atrium was diagnosed by transthoracic echocardiogaphy either early (in 3 cases) or late (in one cases) postoperatively. Predisposing haemodynamic abnormalities could be identified in all four patients, but no patient was found to have severe abnormalities of coagulation. Two patients presented with acute clinical symptoms on the third and twelfth day after initial surgery. They underwent emergency reoperation with thrombectomy followed by prophylactic treatment with coumadin or aspirin after initial heparinization. In the other 2 patients, routine postoperative echocardiography revealed a right atrial thrombus without specific clinical symptoms 25 days or 3 months postoperatively. Thrombolytic therapy with an initial bolus of tissue plasminogen activator (0.1 mg/kg) followed by continuous infusion (1 mg/kg/day) combined with heparinization yielded complete resolution of the thrombus after 27 and 40 hours, respectively, as demonstrated on follow-up echocardiograms. Our own experience, coupled with a review of the literature, indicate that prophylactic anticoagulation therapy with coumadin should continue for at least 4 to 6 months for patients with an increased risk for postoperative thrombosis. For infants and young children with a low risk for postoperative thrombosis, aspirin should be given routinely for 6 months postoperatively.

Keywords

Fontan-operationvenous-thrombosisthrombolysistissue plasminogen activator
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 37 - 43
Copyright
Copyright © Cambridge University Press 1997

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