Coagulation profile, hepatic function, and hemodynamics following Fontan-type operations

Citation
H. Tomita et al., Coagulation profile, hepatic function, and hemodynamics following Fontan-type operations, CARD YOUNG, 11(1), 2001, pp. 62-66
Citations number
16
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics
Journal title
CARDIOLOGY IN THE YOUNG
ISSN journal
1047-9511 → ACNP
Volume
11
Issue
1
Year of publication
2001
Pages
62 - 66
Database
ISI
SICI code
1047-9511(200101)11:1<62:CPHFAH>2.0.ZU;2-R
Abstract
We analyzed retrospectively the relationship between coagulation profile, a nd either hepatic function or hemodynamics, in patients who had undergone a Fontan-type procedure, comparing them, first, with a control group of 12 p atients without significant hemodynamic abnormality, and, second, with a gr oup of 14 patients who had not undergone a Fontan procedure, but whose mean right atrial pressure exceeded 8 mmHg. Follow-up catheterization had been performed in all 30 patients submitted to the Fontan-type operation. Prothr ombin time, and factor XIII, were significantly lower in those who had unde rgone the Fontan procedure than in the other groups. Those submitted to the Fontan operation also had lower levels of protein C than controls, and the ir levels of plasminogen were lower than the patients with high right atria l pressure. Both aspartate aminotransferase and alanine aminotransferase we re higher in those undergoing the Fontan procedure than in the other groups , while gamma-glutamyltranspeptidase in these patients was higher than in t he control group. Mean right atrial pressure was highest in those undergoin g the Fontan procedure, while cardiac index was lowest. Prothrombin time wa s correlated to some extent with aspartate aminotransferase, mean right atr ial pressure, and cardiac index. Protein C correlated with both aspartate a minotransferase and mean right atrial pressure, while factor XIII correlate d with alanine aminotransferase, mean right atrial pressure, and cardiac in dex. Aspartate aminotransferase, alanine aminotransferase, and gamma-glutam yltranspeptidase, parameters of hepatic function, correlated significantly with mean right atrial pressure. In those who had undergone the Fontan proc edure, decreased synthesis of pro-and anti-coagulant factors is a risk fact or fur both thrombosis and bleeding. Abnormal hemodynamics, in the absence of a right sided pumping chamber, may predispose to subclinical hepatic dys function, leading to selective disturbances of protein synthesis.