CONICET | Buscador de Institutos y Recursos Humanos

Introduction: Fontan operation (FO) is performed in children with congenital heart defects. Thromboembolic events (TE) have been reported early and late after surgery, with an overall incidence as high as 33%. As certain risk factors may predispose to TE, we conducted a prospective cohort study to evaluate whether D-dimer (DD), vena cava or extracardiac conduit spontaneous echo contrast (SEC) related to severe low flow, or both correlate with the occurrence of TE in children after the FO.Fontan operation (FO) is performed in children with congenital heart defects. Thromboembolic events (TE) have been reported early and late after surgery, with an overall incidence as high as 33%. As certain risk factors may predispose to TE, we conducted a prospective cohort study to evaluate whether D-dimer (DD), vena cava or extracardiac conduit spontaneous echo contrast (SEC) related to severe low flow, or both correlate with the occurrence of TE in children after the FO. Methods: We enrolled 58 patients (pts) anticoagulated with acenocoumarol (INR target: 2.0-3.0) who underwent the same type FO (with a PTFE extracardiac graft conduit), and compared findings with 27 age-matched healthy controls. DD was assayed by ELISA method (VIDAS, bioMerieux). We established a cut off value from our control group,97.5% of values were below 455 ng/ml. Transthoracic echocardiography analyzed the presence of SEC or thrombosis. Data was tested by Pearson's correlation and t-test method.We enrolled 58 patients (pts) anticoagulated with acenocoumarol (INR target: 2.0-3.0) who underwent the same type FO (with a PTFE extracardiac graft conduit), and compared findings with 27 age-matched healthy controls. DD was assayed by ELISA method (VIDAS, bioMerieux). We established a cut off value from our control group,97.5% of values were below 455 ng/ml. Transthoracic echocardiography analyzed the presence of SEC or thrombosis. Data was tested by Pearson's correlation and t-test method. Results: Age and DD among pts and controls are shown in table 1. DD values were lower than our cut off in 86% of pts(mean 17286.5ng/ml). We found a statistically significant negative correlation between age and DD in both, pts and control groups (p 0.013 and p 0.0095, respectively). Pts mean DD was lower than control group (p 0.0031). 14% of pts had DD over the cut off value. Five pts had SEC but non intracardiac thrombus was found. No association was found between DD or SEC and TE considering all patients. Only 1 ischemic stroke occurred during follow up (0.62/100 patient-year).Age and DD among pts and controls are shown in table 1. DD values were lower than our cut off in 86% of pts(mean 17286.5ng/ml). We found a statistically significant negative correlation between age and DD in both, pts and control groups (p 0.013 and p 0.0095, respectively). Pts mean DD was lower than control group (p 0.0031). 14% of pts had DD over the cut off value. Five pts had SEC but non intracardiac thrombus was found. No association was found between DD or SEC and TE considering all patients. Only 1 ischemic stroke occurred during follow up (0.62/100 patient-year). Table: Control N=27 Patients N=58 Age: mean (range) 9.2 (2-18 years) 9.9 (2-21 years) D-dimer (ng/ml) mean SD (CI 95%) 26199.1 (218-297) 248.7181.7 (201-296.5) Conclusions: DD values in anticoagulated pts were significantly lower than in the control group. A negative correlation between age and DD was evident in both groups stressing the importance of appropriate age-matched reference ranges when comparing children. No association was found between DD or SEC, and TE. DD values in anticoagulated pts were significantly lower than in the control group. A negative correlation between age and DD was evident in both groups stressing the importance of appropriate age-matched reference ranges when comparing children. No association was found between DD or SEC, and TE. Reach the World Travel Grant