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Clinical Importance of Fontan Circuit Thrombus in the Adult Population: Significant Association With Increased Risk of Cardiovascular Events
- Source :
- The Canadian journal of cardiology. 35(12)
- Publication Year :
- 2019
-
Abstract
- Background The impact of Fontan circuit thrombus is poorly understood. The objectives of this study were to determine (1) the incidence of Fontan circuit thrombus and proportion of silent thrombus; (2) any association between Fontan circuit thrombus and markers of Fontan circulatory dysfunction; and (3) the association of Fontan circuit thrombus with adverse cardiac outcomes. Methods We conducted a retrospective review of adult patients who underwent the Fontan procedure (aged > 18 years) followed at St. Paul’s Hospital who underwent cardiac computed tomography or magnetic resonance imaging assessment (n = 67). Fontan circulatory dysfunction markers included clinical heart failure, N-terminal pro-brain natriuretic peptide, ventricular dysfunction, atrioventricular valvular regurgitation, refractory arrhythmias, declining exercise capacity, and hepatic/renal dysfunction. Adverse cardiac outcomes were death, heart transplantation, or surgery for Fontan revision or atrioventricular valve replacement. Results Fontan circuit thrombus was present in 15 of 67 patients (22%): 41% (7/17) classic/modified Fontan and 16% (8/50) total cavopulmonary connection. Incidence was 36% among those suspected to have Fontan circuit thrombus; 14% in those with no clinical/echocardiographic suspicion; and clinically silent in 40% diagnosed with Fontan thrombus. The time from Fontan surgery to Fontan circuit thrombus diagnosis was 22 ± 6 years in the classic/modified group vs 14 ± 8 years in the total cavopulmonary connection group (P = 0.03. Fontan circuit thrombus was associated with adverse cardiac outcomes (27% [4/15] vs 8% [4/52], P = 0.02), but there was no difference in Fontan circulatory dysfunction markers. Conclusion Given the incidence of Fontan circuit thrombus and association with adverse cardiac outcomes, routine surveillance of the Fontan circuit should strongly be considered. The identification of thrombus should lead to anticoagulation implementation/optimization, along with screening/intervention for reversible Fontan circulatory issues in an attempt to prevent adverse cardiac outcomes.
- Subjects :
- Adult
Heart Defects, Congenital
Male
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Magnetic Resonance Imaging, Cine
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Fontan Procedure
Risk Assessment
Fontan procedure
Cohort Studies
03 medical and health sciences
Young Adult
0302 clinical medicine
Internal medicine
Cause of Death
Thromboembolism
medicine
Ventricular Dysfunction
Humans
cardiovascular diseases
030212 general & internal medicine
Thrombus
Cause of death
Retrospective Studies
Heart transplantation
medicine.diagnostic_test
British Columbia
business.industry
Magnetic resonance imaging
Retrospective cohort study
Middle Aged
medicine.disease
Prognosis
Survival Analysis
surgical procedures, operative
Echocardiography
Heart failure
Circulatory system
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Pulmonary Embolism
human activities
Subjects
Details
- ISSN :
- 19167075
- Volume :
- 35
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- The Canadian journal of cardiology
- Accession number :
- edsair.doi.dedup.....d8b72925c0f9bc4cfdd1e5261acd161f