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Thromboembolic complications in adult congenital heart disease: the knowns and the unknowns

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Abstract

Despite impressive improvement in long-term survival, adults with congenital heart disease (CHD) remain exposed to a significant cardiovascular morbidity over lifetime. Thromboembolic events (TE) are a major issue. Specific anatomic groups have been shown a particular high risk of TE, including cyanotic heart disease and Fontan circulation. Many intercurrent clinical factors add a substantial risk such as intracardiac medical devices, atrial arrhythmia, endocarditis, or pregnancy. Nevertheless, what is unknown exceeds what is known, especially regarding the management of this heterogenous patient population. Anticoagulation decision should always be individualized weighing balanced with the alternative risk of hemorrhagic complications. In this review, we aim to synthetize existing literature on TE in adults with CHD, discuss management issues, highlight gaps in knowledge, and intend to suggest high priority research.

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Abbreviations

CHD:

Congenital heart disease

NOAC:

Non-vitamin K antagonist oral anticoagulants

TE:

Thromboembolic event

VHD:

Valvular heart disease

VKA:

Vitamin K antagonists

References

  1. Baumgartner H (2014) Geriatric congenital heart disease: a new challenge in the care of adults with congenital heart disease? Eur Heart J 35:683–685

    Article  PubMed  Google Scholar 

  2. Moons P, Bovijn L, Budts W, Belmans A, Gewillig M (2010) Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 122:2264–2272

    Article  PubMed  Google Scholar 

  3. Engelfriet P, Boersma E, Oechslin E et al (2005) The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. The Euro Heart Survey on adult congenital heart disease. Eur H J 26:2325–2333

    Article  Google Scholar 

  4. Lanz J, Brophy JM, Therrien J, Kaouache M, Guo L, Marelli AJ (2015) Stroke in adults with congenital heart disease: incidence, cumulative risk, and predictors. Circulation 132:2385–2394

    Article  PubMed  Google Scholar 

  5. Ammash N, Warnes CA (1996) Cerebrovascular events in adult patients with cyanotic congenital heart disease. J Am Coll Cardiol 28:768–772

    Article  CAS  PubMed  Google Scholar 

  6. Hoffmann A, Chockalingam P, Balint OH et al (2010) Cerebrovascular accidents in adult patients with congenital heart disease. Heart 96:1223–1226

    Article  CAS  PubMed  Google Scholar 

  7. Nieminen HP, Jokinen EV, Sairanen HI (2007) Causes of late deaths after pediatric cardiac surgery: a population-based study. J Am Coll Cardiol 50:1263–1271

    Article  PubMed  Google Scholar 

  8. Raissadati A, Nieminen H, Haukka J, Sairanen H, Jokinen E (2016) Late causes of death after pediatric cardiac surgery: a 60-year population-based study. J Am Coll Cardiol 68:487–498

    Article  PubMed  Google Scholar 

  9. Karsenty C, Zhao A, Marijon E, Ladouceur M (2018) Risk of thromboembolic complications in adult congenital heart disease: a literature review. Archiv Cardiovasc Dis 111:613–620

    Article  Google Scholar 

  10. Alsaied T, Bokma JP, Engel ME et al (2017) Factors associated with long-term mortality after Fontan procedures: a systematic review. Heart 103:104–110

    Article  PubMed  Google Scholar 

  11. Cheung YF, Chay GW, Chiu CS, Cheng LC (2005) Long-term anticoagulation therapy and thromboembolic complications after the Fontan procedure. Int J Cardiol 102:509–513

    Article  CAS  PubMed  Google Scholar 

  12. Seipelt RG, Franke A, Vazquez-Jimenez JF et al (2002) Thromboembolic complications after Fontan procedures: comparison of different therapeutic approaches. Ann Thorac Surgery 74:556–562

    Article  Google Scholar 

  13. Idorn L, Jensen AS, Juul K et al (2013) Thromboembolic complications in Fontan patients: population-based prevalence and exploration of the etiology. Pediatr Cardiol 34:262–272

    Article  CAS  PubMed  Google Scholar 

  14. Egbe AC, Connolly HM, McLeod CJ et al (2016) Thrombotic and embolic complications associated with atrial arrhythmia after fontan operation: role of prophylactic therapy. J Am Coll Cardiol 68:1312–1319

    Article  PubMed  Google Scholar 

  15. d'Udekem Y, Iyengar AJ, Galati JC et al (2014) Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 130:S32–S38

    PubMed  Google Scholar 

  16. Kaulitz R, Ziemer G, Rauch R et al (2005) Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis). J Thorac Cardiovasc Surg 129:569–575

    Article  PubMed  Google Scholar 

  17. Grewal J, Al Hussein M, Feldstein J et al (2013) Evaluation of silent thrombus after the Fontan operation. Congenit Heart Dis 8:40–47

    Article  PubMed  Google Scholar 

  18. Tomita H, Yamada O, Ohuchi H et al (2001) Coagulation profile, hepatic function, and hemodynamics following Fontan-type operations. Cardiol Young 11:62–66

    Article  CAS  PubMed  Google Scholar 

  19. Odegard KC, McGowan FX Jr, Zurakowski D et al (2003) Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 125:1260–1267

    Article  PubMed  Google Scholar 

  20. Ravn HB, Hjortdal VE, Stenbog EV et al (2001) Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart 85:61–65

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Tomkiewicz-Pajak L, Hoffman P, Trojnarska O, Lipczynska M, Podolec P, Undas A (2014) Abnormalities in blood coagulation, fibrinolysis, and platelet activation in adult patients after the Fontan procedure. J Thorac Cardiovas Surg 147:1284–1290

    Article  CAS  Google Scholar 

  22. Cromme-Dijkhuis AH, Henkens CM, Bijleveld CM, Hillege HL, Bom VJ, van der Meer J (1990) Coagulation factor abnormalities as possible thrombotic risk factors after Fontan operations. Lancet 336:1087–1090

    Article  CAS  PubMed  Google Scholar 

  23. Mahle WT, Todd K, Fyfe DA (2003) Endothelial function following the Fontan operation. Am J Cardiol 91:1286–1288

    Article  CAS  PubMed  Google Scholar 

  24. Binotto MA, Maeda NY, Lopes AA (2008) Altered endothelial function following the Fontan procedure. Cardiol Young 18:70–74

    Article  PubMed  Google Scholar 

  25. Chaloupecky V, Svobodova I, Hadacova I et al (2005) Coagulation profile and liver function in 102 patients after total cavopulmonary connection at mid term follow up. Heart 91:73–79

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Procelewska M, Kolcz J, Januszewska K, Mroczek T, Malec E (2007) Coagulation abnormalities and liver function after hemi-Fontan and Fontan procedures—the importance of hemodynamics in the early postoperative period. Eur J Cardio-thorac Surg Off J Eur Assoc Cardio-thorac Surg 31:866–872

    Article  Google Scholar 

  27. Atz AM, Zak V, Mahony L et al (2017) Longitudinal outcomes of patients with single ventricle after the fontan procedure. J Am Coll Cardiol 69:2735–2744

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rychik J (2007) Protein-losing enteropathy after Fontan operation. Congenit Heart Dis 2:288–300

    Article  PubMed  Google Scholar 

  29. Egbe AC, Connolly HM, Niaz T et al (2017) Prevalence and outcome of thrombotic and embolic complications in adults after Fontan operation. Am Heart J 183:10–17

    Article  PubMed  Google Scholar 

  30. Alsaied T, Alsidawi S, Allen CC, Faircloth J, Palumbo JS, Veldtman GR (2015) Strategies for thromboprophylaxis in Fontan circulation: a meta-analysis. Heart 101:1731–1737

    Article  CAS  PubMed  Google Scholar 

  31. Jensen AS, Idorn L, Thomsen C et al (2015) Prevalence of cerebral and pulmonary thrombosis in patients with cyanotic congenital heart disease. Heart 101:1540–1546

    Article  CAS  PubMed  Google Scholar 

  32. Broberg CS, Ujita M, Prasad S et al (2007) Pulmonary arterial thrombosis in eisenmenger syndrome is associated with biventricular dysfunction and decreased pulmonary flow velocity. J Am Coll Cardiol 50:634–642

    Article  PubMed  Google Scholar 

  33. Silversides CK, Granton JT, Konen E, Hart MA, Webb GD, Therrien J (2003) Pulmonary thrombosis in adults with Eisenmenger syndrome. J Am Coll Cardiol 42:1982–1987

    Article  PubMed  Google Scholar 

  34. Martin-Garcia AC, Arachchillage DR, Kempny A et al (2018) Platelet count and mean platelet volume predict outcome in adults with Eisenmenger syndrome. Heart 104:45–50

    Article  CAS  PubMed  Google Scholar 

  35. Lopes AA, Caramuru LH, Maeda NY (2002) Endothelial dysfunction associated with chronic intravascular coagulation in secondary pulmonary hypertension. Clin Appl Thrombosis/hemostas Off J Int Acad Clin Appl Thrombosis/Hemostas 8:353–358

    Article  Google Scholar 

  36. Jensen AS, Johansson PI, Bochsen L et al (2013) Fibrinogen function is impaired in whole blood from patients with cyanotic congenital heart disease. Int J Cardiol 167:2210–2214

    Article  CAS  PubMed  Google Scholar 

  37. Jensen AS, Johansson PI, Idorn L et al (2013) The haematocrit–an important factor causing impaired haemostasis in patients with cyanotic congenital heart disease. Int J Cardiol 167:1317–1321

    Article  CAS  PubMed  Google Scholar 

  38. Kevane B, Allen S, Walsh K et al (2018) Dual endothelin-1 receptor antagonism attenuates platelet-mediated derangements of blood coagulation in Eisenmenger syndrome. J Thrombos Haemostas 16:1572

    Article  CAS  Google Scholar 

  39. Ladouceur M, Benoit L, Basquin A et al (2017) How pregnancy impacts adult cyanotic congenital heart disease: a multicenter observational study. Circulation 135:2444–2447

    Article  PubMed  Google Scholar 

  40. Wood P (1958) The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. BMJ 2:755–762

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Hjortshoj CS, Jensen AS, Sorensen K et al (2017) Epidemiological changes in eisenmenger syndrome in the nordic region in 1977–2012. Heart 103:1353–1358

    Article  PubMed  Google Scholar 

  42. Ionescu-Ittu R, Mackie AS, Abrahamowicz M et al (2010) Valvular operations in patients with congenital heart disease: increasing rates from 1988 to 2005. Ann Thorac Surg 90:1563–1569

    Article  PubMed  Google Scholar 

  43. Horer J, Belli E, Roussin R et al (2018) Evaluation of the adult congenital heart surgery mortality score at two european centers. Ann Thorac Surg 105:1441–1446

    Article  PubMed  Google Scholar 

  44. O'Byrne ML, Glatz AC, Mercer-Rosa L et al (2015) Trends in pulmonary valve replacement in children and adults with tetralogy of fallot. Am J Cardiol 115:118–124

    Article  PubMed  Google Scholar 

  45. Pragt H, van Melle JP, Javadikasgari H et al (2017) Mechanical valves in the pulmonary position: an international retrospective analysis. J Thorac Cardiovasc Surg 154(1371–1378):e1

    Google Scholar 

  46. Toole JM, Stroud MR, Kratz JM et al (2010) Twenty-five year experience with the St. Jude medical mechanical valve prosthesis. Ann Thorac Surg 89:1402–1409

    Article  PubMed  Google Scholar 

  47. Nishida T, Sonoda H, Oishi Y et al (2014) Single-institution, 22-year follow-up of 786 CarboMedics mechanical valves used for both primary surgery and reoperation. J Thorac Cardiovasc Surg 147:1493–1498

    Article  PubMed  Google Scholar 

  48. Caughron H, Kim D, Kamioka N et al (2018) Repeat pulmonary valve replacement: similar intermediate-term outcomes with surgical and transcatheter procedures. JACC Cardiovasc Intervent 11:2495–2503

    Article  Google Scholar 

  49. Jewgenow P, Schneider H, Bokenkamp R et al (2019) Subclinical thrombus formation in bioprosthetic pulmonary valve conduits. Int J Cardiol 281:113–118

    Article  PubMed  Google Scholar 

  50. Hascoet S, Dalla Pozza R, Bentham J et al (2019) Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EuroIntervent J EuroPCR Collaborat Working Group on Intervent Cardiol Eur Soc Cardiol 14:1378–1385

    Google Scholar 

  51. Chakravarty T, Sondergaard L, Friedman J et al (2017) Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet 389:2383–2392

    Article  PubMed  Google Scholar 

  52. Egbe AC, Pislaru SV, Pellikka PA et al (2015) Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors. J Am Coll Cardiol 66:2285–2294

    Article  PubMed  Google Scholar 

  53. Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B (2013) Short and long term complications of device closure of atrial septal defect and patent foramen ovale: meta-analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Intervent Off J Soc Cardiac Angiogr Intervent 82:1123–1138

    Article  Google Scholar 

  54. Nyboe C, Olsen MS, Nielsen-Kudsk JE, Hjortdal VE (2015) Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart 101:706–711

    Article  CAS  PubMed  Google Scholar 

  55. Jalal Z, Hascoet S, Gronier C et al (2018) Long-term outcomes after percutaneous closure of ostium secundum atrial septal defect in the young: a nationwide cohort study. JACC Cardiovasc Intervent 11:795–804

    Article  Google Scholar 

  56. Khairy P, Landzberg MJ, Gatzoulis MA et al (2006) Transvenous pacing leads and systemic thromboemboli in patients with intracardiac shunts: a multicenter study. Circulation 113:2391–2397

    Article  PubMed  Google Scholar 

  57. Bouchardy J, Therrien J, Pilote L et al (2009) Atrial arrhythmias in adults with congenital heart disease. Circulation 120:1679–1686

    Article  PubMed  Google Scholar 

  58. Labombarda F, Hamilton R, Shohoudi A et al (2017) Increasing prevalence of atrial fibrillation and permanent atrial arrhythmias in congenital heart disease. J Am Coll Cardiol 70:857–865

    Article  PubMed  Google Scholar 

  59. Mandalenakis Z, Rosengren A, Lappas G, Eriksson P, Hansson PO, Dellborg M (2016) Ischemic stroke in children and young adults with congenital heart disease. J Am Heart Assoc 5:2

    Article  Google Scholar 

  60. Mandalenakis Z, Rosengren A, Lappas G et al (2018) Atrial fibrillation burden in young patients with congenital heart disease. Circulation 137:928–937

    Article  PubMed  Google Scholar 

  61. Lin YS, Liu PH, Wu LS, Chen YM, Chang CJ, Chu PH (2014) Major adverse cardiovascular events in adult congenital heart disease: a population-based follow-up study from Taiwan. BMC Cardiovasc Disord 14:38

    Article  PubMed  PubMed Central  Google Scholar 

  62. Khairy P, Aboulhosn J, Broberg CS et al (2016) Thromboprophylaxis for atrial arrhythmias in congenital heart disease: a multicenter study. Int J Cardiol 223:729–735

    Article  PubMed  Google Scholar 

  63. Yang H, Bouma BJ, Dimopoulos K et al (2020) Non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prevention, are they safe in congenital heart disease? Results of a worldwide study. Int J Cardiol 299:123–130

    Article  CAS  PubMed  Google Scholar 

  64. Kamel H, Okin PM, Elkind MS, Iadecola C (2016) Atrial fibrillation and mechanisms of stroke: time for a new model. Stroke 47:895–900

    Article  PubMed  PubMed Central  Google Scholar 

  65. Masuda K, Ishizu T, Niwa K et al (2017) Increased risk of thromboembolic events in adult congenital heart disease patients with atrial tachyarrhythmias. Int J Cardiol 234:69–75

    Article  PubMed  Google Scholar 

  66. Heidendael JF, Bokma JP, de Groot JR, Koolbergen DR, Mulder BJ, Bouma BJ (2015) Weighing the risks: thrombotic and bleeding events in adults with atrial arrhythmias and congenital heart disease. Int J Cardiol 186:315–320

    Article  CAS  PubMed  Google Scholar 

  67. Thuny F, Di Salvo G, Belliard O et al (2005) Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 112:69–75

    Article  PubMed  Google Scholar 

  68. Thom K, Hanslik A, Russell JL et al (2018) Incidence of infective endocarditis and its thromboembolic complications in a pediatric population over 30years. Int J Cardiol 252:74–79

    Article  CAS  PubMed  Google Scholar 

  69. Moore B, Cao J, Kotchetkova I, Celermajer DS (2017) Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population. Int J Cardiol 249:161–165

    Article  PubMed  Google Scholar 

  70. Yoshinaga M, Niwa K, Niwa A et al (2008) Risk factors for in-hospital mortality during infective endocarditis in patients with congenital heart disease. Am J Cardiol 101:114–118

    Article  PubMed  Google Scholar 

  71. Karangelis D, Mazine A, Narsupalli S, Mendis S, Veldtman G, Nikolaidis N (2018) Morbidity after cardiac surgery in patients with adult congenital heart disease in comparison with acquired disease. Heart Lung Circ 27:739–744

    Article  PubMed  Google Scholar 

  72. Vida VL, Berggren H, Brawn WJ et al (2007) Risk of surgery for congenital heart disease in the adult: a multicentered European study. Ann Thorac Surg 83:161–168

    Article  PubMed  Google Scholar 

  73. Stefanescu Schmidt AC, Armstrong A, Kennedy KF, Nykanen D, Aboulhosn J, Bhatt AB (2017) Prediction of adverse events after catheter-based procedures in adolescents and adults with congenital heart disease in the IMPACT registry. Eur Heart J 38:2070–2077

    Article  PubMed  PubMed Central  Google Scholar 

  74. Baumgartner H, Bonhoeffer P, De Groot NM et al (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31:2915–2957

    Article  PubMed  Google Scholar 

  75. Galie N, Humbert M, Vachiery JL et al (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (ESC) and the european respiratory society (ERS): endorsed by: association for european paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Respir J 46:903–975

    Article  CAS  PubMed  Google Scholar 

  76. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J et al (2018) 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 39:3165–3241

    Article  PubMed  Google Scholar 

  77. Stout KK, Daniels CJ, Aboulhosn JA et al (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 73:1494–1563

    Article  PubMed  Google Scholar 

  78. Rychik J, Atz AM, Celermajer DS et al (2019) Evaluation and management of the child and adult with fontan circulation: a scientific statement from the american heart association. Circulation 140:e234

    Article  Google Scholar 

  79. Kaemmerer H, Apitz C, Brockmeier K et al (2018) Pulmonary hypertension in adults with congenital heart disease: updated recommendations from the cologne consensus conference 2018. Int J Cardiol 272S:79–88

    Article  PubMed  Google Scholar 

  80. Khairy P, Van Hare GF, Balaji S et al (2014) PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 30:e1–e63

    Article  PubMed  Google Scholar 

  81. Hernandez-Madrid A, Paul T, Abrams D et al (2018) Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace Eur Pacing Arrhythm Cardiac Electrophysiol J Working Group Cardiac Pacing Arrhythm Cardiac Cell Electrophysiol Eur Soc Cardiol 20:1719–1753

    Google Scholar 

  82. Iyengar AJ, Winlaw DS, Galati JC et al (2016) No difference between aspirin and warfarin after extracardiac Fontan in a propensity score analysis of 475 patients. Eur J Cardio-thorac surg Off J Eur Assoc Cardio-thorac Surg 50:980–987

    Article  Google Scholar 

  83. Monagle P, Cochrane A, McCrindle B, Benson L, Williams W, Andrew M (1998) Thromboembolic complications after fontan procedures–the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg 115:493–498

    Article  CAS  PubMed  Google Scholar 

  84. Rosenkranz S, Lang IM, Blindt R et al (2018) Pulmonary hypertension associated with left heart disease: updated recommendations of the cologne consensus conference 2018. Int J Cardiol 272S:53–62

    Article  PubMed  Google Scholar 

  85. Feltes TF, Bacha E, Beekman RH 3rd et al (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123:2607–2652

    Article  PubMed  Google Scholar 

  86. Baumgartner H, Falk V, Bax JJ et al (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739–2791

    Article  PubMed  Google Scholar 

  87. Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 70:252–289

    Article  PubMed  Google Scholar 

  88. Hascoet S, Acar P, Boudjemline Y (2014) Transcatheter pulmonary valvulation: current indications and available devices. Archiv Cardiovasc Dis 107:625–634

    Article  Google Scholar 

  89. Yang H, Veldtman GR, Bouma BJ et al (2019) Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe. Open heart 6:e000985

    Article  PubMed  PubMed Central  Google Scholar 

  90. Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the american college of cardiology/american heart association task force on practice guidelines. Circulation 129:e521–643

    PubMed  Google Scholar 

  91. Marzec LN, Wang J, Shah ND et al (2017) Influence of direct oral anticoagulants on rates of oral anticoagulation for atrial fibrillation. J Am Coll Cardiol 69:2475–2484

    Article  CAS  PubMed  Google Scholar 

  92. January CT, Wann LS, Calkins H et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology 2019.

  93. Mongeon FP, Macle L, Beauchesne LM et al (2019) Non-vitamin K antagonist oral anticoagulants in adult congenital heart disease. Can J Cardiol 35:1686

    Article  PubMed  Google Scholar 

  94. Diller GP, Kempny A, Babu-Narayan SV et al (2019) Machine learning algorithms estimating prognosis and guiding therapy in adult congenital heart disease: data from a single tertiary centre including 10 019 patients. Eur Heart J 40:1069–1077

    Article  PubMed  PubMed Central  Google Scholar 

  95. Greer IA (1999) Thrombosis in pregnancy: maternal and fetal issues. Lancet 353:1258–1265

    Article  CAS  PubMed  Google Scholar 

  96. Toglia MR, Weg JG (1996) Venous thromboembolism during pregnancy. N Eng J Med 335:108–114

    Article  CAS  Google Scholar 

  97. Liu S, Rouleau J, Joseph KS et al (2009) Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can 31:611–620

    Article  PubMed  Google Scholar 

  98. Roos-Hesselink J, Baris L, Johnson M et al (2019) Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J 4:3848

    Article  Google Scholar 

  99. Garcia Ropero A, Baskar S, Roos Hesselink JW et al (2018) Pregnancy in women with a fontan circulation: a systematic review of the literature. Circ Cardiovasc Qual Outcomes 11:e004575

    Article  PubMed  Google Scholar 

  100. Bedard E, Dimopoulos K, Gatzoulis MA (2009) Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 30:256–265

    Article  PubMed  Google Scholar 

  101. Salam AM, Ertekin E, van Hagen IM et al (2015) Atrial fibrillation or flutter during pregnancy in patients with structural heart disease: data from the ROPAC (Registry on pregnancy and cardiac disease). JACC Clin Electrophysiol 1:284–292

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr Ségolène Claeyssens, Pr Philippe Acar

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None.

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Author notes

  1. Sébastien Hascoe and Magalie Ladouceur have contributed equally to this work.

Authors and Affiliations

  1. Pediatric and Congenital Cardiology, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, 330 Avenue de Grande Bretagne, 31300, Toulouse, France

    Clément Karsenty

  2. Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, 1, Avenue Jean Poulhès-BP84225, Toulouse, France

    Clément Karsenty

  3. Electrophysiology Unit and Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, APHP, Paris Descartes University, Paris, France

    Victor Waldmann

  4. Centre de Recherche Cardiovasculaire de Paris, INSERM U970, Paris, France

    Victor Waldmann & Magalie Ladouceur

  5. Department of Cardiology, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands

    Barbara Mulder

  6. Department of Congenital Heart Diseases, Centre de référence Des Malformations Cardiaques Congénitales Complexes M3C, Marie Lannelongue Hospital, Groupe Hospitalier Paris -Saint Joseph, Inserm U999, Paris-Sud University, Orsay, France

    Sébastien Hascoet

  7. Centre de référence Des Malformations Cardiaques Congénitales Complexes, M3C, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, APHP, Paris Descartes University, Paris, France

    Magalie Ladouceur

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Karsenty, C., Waldmann, V., Mulder, B. et al. Thromboembolic complications in adult congenital heart disease: the knowns and the unknowns. Clin Res Cardiol 110, 1380–1391 (2021). https://doi.org/10.1007/s00392-020-01746-2

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