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

Ann Thorac Surg 2002;73:1770-1777
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Coagulation factor abnormalities in patients with single-ventricle physiology immediately prior to the fontan procedure

^a Department of Anesthesia, Children’s Hospital, Boston and Harvard Medical School, Boston, Massachusetts, USA
^b Department of Cardiac Surgery, Children’s Hospital, Boston and Harvard Medical School, Boston, Massachusetts, USA
^c Department of Biostatistics, Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA

Accepted for publication March 1, 2002.

* Address reprint requests to Dr Odegard, Cardiac Anesthesia Service, 300 Longwood Ave, Children’s Hospital, Boston, MA 02115, USA
e-mail: kirsten.odegard{at}tch.harvard.edu

Background. Coagulation abnormalities have been reported following the Fontan operation and have been attributed to various aspects of Fontan-associated physiology. Using age-matched controls, this study evaluated coagulation abnormalities in children who had undergone a bidirectional Glenn procedure to test the hypothesis that coagulation abnormalities are present before the Fontan operation.

Methods. Coagulation factors were assayed in 38 children (mean age 34.4 ± 15 months) immediately before the Fontan operation; 37 healthy children (mean age 33 ± 17 months) were assayed as controls. Concentration of factors II, V, VII, VIII, IX, and X and of antithrombin III, 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 data, hemodynamic variables, and elapsed time after the Glenn procedure were evaluated as possible predictors of coagulation abnormalities.

Results. Concentrations of protein C; factors II, V, VII, and X; plasminogen; and antithrombin III were significantly lower before the Fontan operation compared with age-matched controls (p < 0.01); no specific hemodynamic variables were predictive of a pro- or anticoagulant deficiency. There were significant positive correlations between patients who had abnormally low factor VII, protein S, and protein C levels and a longer interval between the bidirectional Glenn procedure and the Fontan operation (p < 0.001).

Conclusions. Coagulation abnormalities that could predispose patients to increased risk for clotting or bleeding are evident early in the course of staged single-ventricle repair.

This article has been cited by other articles:

				K. C. Odegard, D. Zurakowski, J. A. DiNardo, R. A. Castro, F. X. McGowan Jr., E. J. Neufeld, and P. C. Laussen Prospective longitudinal study of coagulation profiles in children with hypoplastic left heart syndrome from stage I through Fontan completion J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 934 - 941. [Abstract] [Full Text] [PDF]

				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]

				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]

				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]

				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]