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Two Cases of Warfarin-Induced Tracheobronchial Calcification After Fontan Surgery

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Abstract

This study identified tracheobronchial cartilage calcification in children with congenital heart disease. Calcification of the tracheobronchial airways has been found previously in adults receiving warfarin and in children receiving warfarin after mitral valve replacement. A 9-year-old girl who had received a Fontan repair 6 years previously underwent a cardiac computed tomography (CT) scan to evaluate pulmonary artery size. The result was an incidental finding of extensive tracheobronchial cartilage calcification. A retrospective review of all pediatric Fontan patients who had undergone cardiac CT was conducted to search for calcification of the tracheobronchial cartilage. The study investigated ten pediatric Fontan patients who had undergone cardiac CT scanning. Two patients with extensive calcification of the tracheobronchial airways were identified. The index case had hypoplastic left heart syndrome, and the patient had undergone a staged repair with the Fontan at the age of 3 years. A 16-year-old boy with tricuspid atresia had undergone staged repair and Fontan at the age of 3.5 years. These two patients had received continuous warfarin therapy for 6 and 13 years, respectively. Other common causes of airway calcification were excluded from the study. This report describes warfarin-induced tracheobronchial calcification in patients after the Fontan procedure. This finding has possible implications for airway growth and vascular calcification.

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Acknowledgments

We thank Dr. Nicola Webster and Dr. Andrew Aitken for providing clinical data on their patients.

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Authors and Affiliations

  1. Green Lane Paediatric and Congenital Cardiology Services, Starship Hospital, Victoria Street West, Private Bag 92024, Auckland, 1142, New Zealand

    Luke Eckersley, John Stirling & Nigel Wilson

  2. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

    Christopher Occleshaw

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  1. Luke Eckersley
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  2. John Stirling
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  3. Christopher Occleshaw
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  4. Nigel Wilson
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Correspondence to Nigel Wilson.

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Eckersley, L., Stirling, J., Occleshaw, C. et al. Two Cases of Warfarin-Induced Tracheobronchial Calcification After Fontan Surgery. Pediatr Cardiol 35, 954–958 (2014). https://doi.org/10.1007/s00246-014-0880-z

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  • DOI: https://doi.org/10.1007/s00246-014-0880-z

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