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J Thorac Cardiovasc Surg 1999;117:1038
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Coagulation factor abnormalities after the Fontan procedure and its modifications

Thierry Sluysmans, MD, Caroline Ovaert, MD, Yves d'Udekem, MD, Cathy Barrea, MD

Pediatric Cardiology
Cliniques St Luc
Université Catholique de Louvain
Brussels, Belgium

Coagulation factor abnormalities after the Fontan procedure and its modifications

To the Editor:

Recently, the publication by Jahangiri and associatesGo 1 suggested coagulation factor abnormalities, principally low levels of protein C, as contributing factors to thromboembolism in patients who underwent the Fontan operation.

They expressed the concentrations of the coagulant and anticoagulant factors as percentages of the concentration in pooled normal plasma set at 100%. Protein C was found to be below the normal range (63%-144%) in 15 of the 20 patients tested.

However, the ages of their patients ranged from 17 months to 13 years, whereas in normal children aged 1 to 5 years the mean value of protein C is 68% of the mean value of the pooled normal plasma (normal range 41%-95%).Go 2 In normal children aged 6 to 10 years, the mean value of protein C is 71% of the pooled normal plasma (normal range 46%-96%).Go 3 A significant proportion of their patients (±50%) were expected to have a value below the lower limit (63%), just because of their age and not because of their surgical condition. The same observation could probably explain partially the report of coagulation factor abnormalities after Fontan operations by Cromme-Dijkuis and associates.Go 4 In their publications, they compared protein C level in their patients (aged 4-23 years, median 10.5 years) with the normal ranges established in a group of 59 healthy volunteers, even though adults are probably the only ones to volunteer for plasma donation.

Before suggesting that a postoperative decrease of protein C should be regarded as a risk factor of thromboembolism after the Fontan operation, with the proposition to give anticoagulants, this study needs to be validated either with age-matched normal subjects or with the patients' values before surgery as control values.

12/8/96854

References

  1. Jahangiri M, Shore D, Kakkar V, Lincoln C, Shinebourne EA. Coagulation factor abnormalities after the Fontan procedures and its modifications. J Thorac Cardiovasc Surg 1997;113:989-93. [Abstract/Free Full Text]
  2. Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood 1992;80:1998-2005. [Abstract/Free Full Text]
  3. Andrew M. Developmental hemostasis: relevance to hemostatic problems during childhood. Semin Thromb Hemost 1995;21:341-53. [Medline]
  4. Cromme-Dijkuis AH, Henkens CMA, Byleveld CMA, Hillege HL, Bom VJJ, Van der Meer J. Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations. Lancet 1990;336:1087-90. [Medline]



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This Article
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