HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pedro J. del Nido Peter C. Laussen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Odegard, K. C. Articles by Laussen, P. C. Search for Related Content PubMed PubMed Citation Articles by Odegard, K. C. Articles by Laussen, P. C. Related Collections Congenital - cyanotic

J Thorac Cardiovasc Surg 2003;125:1260-1267
© 2003 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: Increased factor VIII may predispose to thrombosis

From the Departments of Anesthesia, Cardiac Surgery, and Biostatistics, Children's Hospital, Boston, and Harvard Medical School, Boston, Mass.

Received for publication April 25, 2002. Revisions received July 17, 2002. Accepted for publication Aug 27, 2002. Address for reprints: Kirsten C. Odegard, MD, Cardiac Anesthesia Service, 300 Longwood Avenue, Children's Hospital, Boston, MA 02115 (E-mail: kirsten.odegard{at}tch.harvard.edu).

Objective: Using age-matched controls, this study prospectively evaluated coagulation factor abnormalities and hemodynamic variables in children who had undergone the Fontan operation.
Methods: Coagulation factors were assayed in 20 children (mean age 6.4 ± 2.9 years), at a mean 3.7 ± 2.3 years after the Fontan procedure; 24 healthy children (mean age 6.8 ± 2.8 years) were assayed as controls. Concentration of factors II, V, VII, VIII, IX, X; ATIII; plasminogen; proteins C and S; fibrinogen; serum albumin; and liver enzymes were measured. Normal reference intervals based on the control patients were determined using 95% confidence limits. Patient demographic, hemodynamic variables, and elapsed time after the Fontan procedure were evaluated as possible predictors of coagulation abnormalities.
Results: Concentrations of protein C; factors II, V, VII, X; plasminogen; and ATIII were significantly lower in Fontan patients compared with age-matched controls (P < .01); factor VIII was significantly elevated in 6 patients (35%), 2 of whom had a thromboembolic event. A higher superior vena cava pressure was predictive of an elevated factor VIII level (P = .003). No other specific hemodynamic variables were predictive of a procoagulant or anticoagulant abnormality.
Conclusion: Procoagulant and anticoagulant factor levels were significantly lower in patients after the Fontan operation independent of hemodynamic variables peculiar to the Fontan circulation. Increased factor VIII level requires further evaluation as a cause of thrombosis in patients with Fontan physiology and may also indicate a subset of these patients in whom anticoagulation is indicated.

This article has been cited by other articles:

				S. Camposilvan, O. Milanesi, G. Stellin, A. Pettenazzo, L. Zancan, and L. D'Antiga Liver and cardiac function in the long term after fontan operation. Ann. Thorac. Surg., July 1, 2008; 86(1): 177 - 182. [Abstract] [Full Text] [PDF]

				T. Nakano, H. Kado, T. Tachibana, K. Hinokiyama, A. Shiose, M. Kajimoto, and Y. Ando Excellent Midterm Outcome of Extracardiac Conduit Total Cavopulmonary Connection: Results of 126 Cases Ann. Thorac. Surg., November 1, 2007; 84(5): 1619 - 1626. [Abstract] [Full Text] [PDF]

				M. Procelewska, J. Kolcz, K. Januszewska, T. Mroczek, and E. Malec Coagulation abnormalities and liver function after hemi-Fontan and Fontan procedures -- the importance of hemodynamics in the early postoperative period Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 866 - 872. [Abstract] [Full Text] [PDF]

				K. C. Odegard, D. Zurakowski, S. Hornykewycz, J. A. DiNardo, R. A. Castro, E. J. Neufeld, and P. C. Laussen Evaluation of the Coagulation System in Children with Two-Ventricle Congenital Heart Disease Ann. Thorac. Surg., May 1, 2007; 83(5): 1797 - 1803. [Abstract] [Full Text] [PDF]

				J. Guay Invited commentary Ann. Thorac. Surg., May 1, 2007; 83(5): 1803 - 1804. [Full Text] [PDF]

				A. C. Fiore, M. Turrentine, M. Rodefeld, P. Vijay, T. L. Schwartz, K. S. Virgo, L. K. Fischer, and J. W. Brown Fontan Operation: A Comparison of Lateral Tunnel with Extracardiac Conduit Ann. Thorac. Surg., February 1, 2007; 83(2): 622 - 630. [Abstract] [Full Text] [PDF]

				C. D. McClain, F. X. McGowan, and P. G. Kovatsis Laparoscopic Surgery in a Patient with Fontan Physiology Anesth. Analg., October 1, 2006; 103(4): 856 - 858. [Abstract] [Full Text] [PDF]

				A. M. Ostrow, H. Freeze, and J. Rychik Protein-Losing Enteropathy After Fontan Operation: Investigations Into Possible Pathophysiologic Mechanisms Ann. Thorac. Surg., August 1, 2006; 82(2): 695 - 700. [Abstract] [Full Text] [PDF]

				H A Walker and M A Gatzoulis Prophylactic anticoagulation following the Fontan operation Heart, July 1, 2005; 91(7): 854 - 856. [Full Text] [PDF]

				R Kaulitz and M Hofbeck Current treatment and prognosis in children with functionally univentricular hearts Arch. Dis. Child., July 1, 2005; 90(7): 757 - 762. [Abstract] [Full Text] [PDF]

				M. L. Jacobs The Fontan operation, thromboembolism, and anticoagulation: A reappraisal of the single bullet theory J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 491 - 495. [Full Text] [PDF]

				R. Kaulitz, G. Ziemer, R. Rauch, M. Girisch, H. Bertram, A. Wessel, and M. Hofbeck Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis) J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 569 - 575. [Abstract] [Full Text] [PDF]

				V Chaloupecky, I Svobodova, I Hadacova, V Tomek, B Hucin, T Tlaskal, J Janousek, O Reich, and J Skovranek Coagulation profile and liver function in 102 patients after total cavopulmonary connection at mid term follow up Heart, January 1, 2005; 91(1): 73 - 79. [Abstract] [Full Text] [PDF]