Original Article

Pediatric Cardiology

, Volume 30, Issue 6, pp 771-776

First online:

Thromboelastography of Patients After Fontan Compared with Healthy Children

  • Leslie RaffiniAffiliated withDivision of Hematology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine Email author 
  • , Alexander SchwedAffiliated withUniversity of Pennsylvania School of Medicine
  • , X. Long ZhengAffiliated withDepartment of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine
  • , Maria TanzerAffiliated withDepartment of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine
  • , Susan NicolsonAffiliated withDivision of Cardiac Anesthesia, Department of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine
  • , J. William GaynorAffiliated withDivision of Cardiothoracic Surgery, Department of Surgery, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine
  • , David JobesAffiliated withDivision of Cardiac Anesthesia, Department of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine

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Abstract

Patients who have undergone a Fontan procedure face an increased risk for thromboembolic complications. This study aimed to evaluate whether thromboelastography, a global whole-blood assay of coagulation, can be used to detect hypercoagulability in pediatric Fontan patients compared with healthy children. This prospective, cross-sectional study investigated 25 Fontan patients and 51 healthy children in three age groups: 1–5 years, 6–10 years, and 11–16 years. Kaolin-activated thromboelastography was performed on citrated samples. No statistically significant differences in thromboelastography parameters were found among the different age groups of the 51 healthy children. None of the 25 Fontan patients demonstrated evidence of hypercoagulability on thromboelastography (95% confidence interval, 0–7%), as defined by two standard deviations above or below the normal mean. The findings suggest that the percentage of Fontan patients demonstrating hypercoagulability on thromboelastography is substantially lower than the reported incidence of thromboembolic complications. Whether thromboelastography could be helpful in predicting patients at increased risk for thromboembolic complications or not still is not known. Further studies comparing the thromboelastography of Fontan patients with the thromboembolic complications of those without Fontan are needed to delineate these issues.

Keywords

CHD Fontan Hematology Thrombosis