THROMBOEMBOLIC COMPLICATIONS AFTER FONTAN OPERATIONS
THROMBOEMBOLIC COMPLICATIONS AFTER FONTAN OPERATIONS
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DOI：
10.1161/01.cir.92.9.287
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发表时间：
1995-11-01
期刊：
影响因子：
37.8
通讯作者：
HELLENBRAND, WE
中科院分区：
文献类型：
--
作者：
ROSENTHAL, DN;FRIEDMAN, AH;HELLENBRAND, WE
背景尽管Fontan手术的血栓栓塞并发症越来越多地被认识到，但描述此类事件的数据有限。与Fontan手术的其他改进相比，全腔静脉连接术被认为不太容易发生这种并发症。我们研究了我们的经验，Fontan手术后血栓栓塞，以更好地描述这些事件和它们的关系类型的Fontan operation performed.Methods和结果我们回顾性地确定了70例谁进行了Fontan手术1978年1月至1994年3月。患者分为三组：（1）全腔静脉连接，（2）心房连接，（3）导管插入。在平均（+/-SD）5.2+/-4.7年随访期间，14例患者（20%）发生血栓栓塞并发症。各组的血栓形成率相似。Fontan手术至血栓形成的时间平均为6.1 ± 5.0年。血栓栓塞事件的总体发生率为3.9/100患者-年。14个血栓中有12个位于静脉循环内，1个位于左心室内，1个位置不明。6例患者（43%）无症状，3例（21%）出现脑血管事件，5例（36%）出现其他症状。血栓栓塞事件发生从围手术期到术后15年。结论血栓栓塞并发症经常发生后Fontan手术及其修改，是一个显着的发病率的原因。介绍的时间差别很大。在Fontan手术的所有改良中，血栓形成的发生率似乎相似。
Background Despite the increasing recognition of thromboembolic complications of the Fontan procedure, data characterizing such events are limited. The total cavopulmonary connection is believed to be less prone to this complication than other modifications of Fontan operations. We examined our experience with thromboembolism after Fontan operations to better characterize these events and their relation to the type of Fontan operation performed.Methods and Results We retrospectively identified 70 patients who underwent a Fontan operation between January 1978 and March 1994. Patients were divided into three groups: (1) total cavopulmonary connection, (2) atriopulmonary connection, and (3) conduit interposition. Fourteen patients (20%) developed a thromboembolic complication during a mean (+/-SD) follow-up of 5.2+/-4.7 years. The rate of thrombosis was similar in each group. The time from Fontan operation to thrombosis averaged 6.1+/-5.0 years. The overall rate of thromboembolic events was 3.9 per 100 patient-years. Twelve of the 14-thrombi were located within the venous circulation, 1 was in the left ventricle, and the location of 1 was undetermined. Six of the patients (43%) were asymptomatic, 3 (21%) presented with cerebrovascular events, and 5 (36%) presented with other symptoms. Thromboembolic events occurred from the perioperative period to 15 years after surgery.Conclusions Thromboembolic complications occur frequently after the Fontan operation and its modifications and are a cause of significant morbidity. The time of presentation varies greatly. The rate of thrombosis appears to be similar in all modifications of the Fontan operation.