Thrombosis of Extra-cardiac Fontan, an Institutional Experience
Mohammed Al-Biltagi *
Department of Pediatric, Faculty of Medicine, Tanta University, Egypt
Amjad Al-Kouatli
Department of Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Jameel Al-Ata
Department of Cardiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Ahmad Jamjoom
Department of Cardiovascular, Cardiothoracic Surgery Section, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Heba Abouzeid
Department of Pediatrics and Cardiovascular, Pediatric Cardiology Section, King Faisal Specialist Hospital and Research Center – Jeddah, Saudi Arabia and Faculty of Medicine, Zagazig University, Egypt
*Author to whom correspondence should be addressed.
Abstract
Background: Thromboembolism can complicate Fontan surgery. There are few well designed studies in the literature to determine the epidemiology of thrombosis after Fontan.
Methods: We report the experience of King Faisal Specialist Hospital & Research Center- Jeddah, Kingdom of Saudi Arabia; regarding thrombosis of extra-cardiac Fontan pathways in 3 of our patients; two patients were post- Fontan operation and one patient was post- Kawashima procedure & hepatic vein incorporation.
Results: The first and second patients developed thrombosis of Fontan pathways at one month & one year postoperatively respectively. In both patients, stenting of the extra-cardiac contegra re-established the patency of Fontan circuit and saved the risks of redo-surgeries. In the third patient, conduit occlusion was diagnosed 5 months postoperatively. Several attempts of cardiac catheterizations failed to penetrate the thrombosed conduit. Surgical re-intervention was inevitable. Conclusions: The threshold for diagnostic and interventional cardiac catheterization should be lowered in post Fontan operation. Chronic oral anticoagulation may not prevent development of thrombosis despite therapeutic international normalized ratio (INR).
Keywords: Children, fontan, kawashima, thrombosis