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Title: The evaluation of coagulation abnormalities in patients with single ventricle after the Fontan operation
Abstract:
The staged Fontan approach is nowadays widely used to treat children with single ventricle. Its goal is to connect the systemic venous return with the pulmonary arteries and to use the only ventricle as the systemic ventricle. The aim of the surgical intervention in the neonatal period is to create a balanced pulmonary and systemic circulation. During the next stage (the hemi-Fontan operation or the bidirectional Glenn shunt) the superior vena cava is connected with the pulmonary arteries. After this procedure upper body part has increased venous pressure. Following the last stage (the Fontan operation) blood from the inferior vena cava is driven to the pulmonary arteries causing elevation in the central venous pressure in the lower body part and the liver. The palliative nature of the Fontan procedure is associated with many complications in the postoperative period, including hepatic failure, pleural effusions, protein-losing enteropathy, arrhythmias, thromboembolic complications and coagulation abnormalities. The possible factors associated with changes in the haemostatic system are liver dysfunction, hypoxia, decreased absorption and synthesis of vitamin K, single ventricular dysfunction and hemodynamic changes. The study was designed to assess the coagulation profile in children with functionally single ventricle in the early postoperative period after the hemi-Fontan and ; Fontan procedure and the influence of the perioperative factors on the coagulation status of the blood. A consecutive series of 81 children with single ventricle who were qualified for the staged Fontan palliation (hemi-Fontan or Fontan operation) in a single institution were enrolled to a study. Blood samples were obtained from patients before the surgery in the operating room, 24 hours after the surgery and on the fifth postoperative day. For the assessment of liver function, serum concentration of total protein, albumin, total bilirubin, aspartate aminotransferase and alanine aminotransferase were measured. For the evaluation of coagulation profile, the concentration of fibrinogen and activity of prothrombin, factor VII, factor VIII, antithrombin III and INR were measured. The perioperative data were derived from cardiac catheterization, postoperative echocardiographic examination and medical records. In the postoperative period there was transitional increase in activity of aspartate and alanine aminotransferase and concentration of bilirubin both after the hemi-Fontan and Fontan procedure. The elevated activity of both aminotransferases on the fifth postoperative day was observed only in the Fontan group. There was a significant influence of the atrioventricular valve regurgitation on the activity of aspartate aminotransferase, alanine aminotransferase and bilirubin concen ; tration in this group. In the preoperative period the decreased concentration of fibrinogen, activity of prothrombin, factor VII, VIII and antithrombin III was observed in patients from both groups. There was a significant relation of blood saturation to the activity of factor VII before the surgery. The increase in saturation after the hemi-Fontan procedure may contribute to partial correction of observed abnormalities in prothrombin, factor VII and fibrinogen. On the first postoperative day there was a significant decrease in activity of prothrombin, factor VII, antithrombin III and increase in activity of factor VIII in both groups. Five days after the surgery the noteworthy coagulation abnormalities (decreased prothrombin, factor VII and antithrombin III activity, increased factor VIII activity) were observed only in the Fontan group. Children with pleura! effusions had significantly lower concentration of total serum protein, fibrinogen as well as activity of factor VII and antithrombin III. There was a significant influence of the hemodynamic factors ( central venous pressure, decreased ventricular function, elevated end-diastolic ventricular pressure, higher systemic saturation before the surgery) on the activity of particular coagulation factors in patients after the Fontan procedure. In the hemi-Fontan group no relation was found between the hemodynamic variables and a ; bnormalities in the haemostatic system. The study demonstrates a high incidence of both procoagulant and anticoagulant factors abnormalities m patients with single ventricle during staged Fontan approach in the early postoperative period. Hypoxia, liver dysfunction, hemodynamic factors, and pleura! Effusions contribute to changes m coagulation profile. Observed abnormalities in the haemostatic system may increase the risk of thromboembolic complications and bleeding in children undergoing the Fontan operation. In higher risk patients adjusting the adequate prophylactic anticoagulation strategy may decrease the incidence of postoperative complications.
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Last modified:
Jul 19, 2022
In our library since:
Nov 21, 2012
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http://dl.cm-uj.krakow.pl:8080/publication/956
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| Edition name | Date |
|---|---|
| ZB-106442 | Jul 19, 2022 |
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