Jacobs M L, Pourmoghadam K K
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134, USA.
Pediatr Cardiol. 2007 Nov-Dec;28(6):457-64. doi: 10.1007/s00246-007-9006-1.
Among factors contributing to morbidity and failure of the Fontan circulation is the group of events referred to as thromboembolic complications. These events have been variously attributed to low flow states, stasis in the venous pathways, right-to-left shunts, blind cul-de-sacs, prosthetic material, atrial arrhythmias, and hypercoagulable states. Numerous investigations, most retrospective, have been undertaken to characterize thromboembolic events; describe the frequency and circumstances of these occurrences; and relate the risk of these events to patient, surgical, hemodynamic, and hematologic factors. Practices vary widely with respect to strategies of prophylactic anticoagulation in the hopes of minimizing the occurrence and morbidity of thromboembolism after Fontan operations. Review of the literature suggests that the factors associated with thromboembolic events after Fontan operations likely represent a complex field of biologic factors with multiple interactions. It is unlikely that a single agent will represent the solution to this complex problem.
在导致Fontan循环发病和功能衰竭的因素中，有一类事件被称为血栓栓塞并发症。这些事件的发生原因多种多样，包括低流量状态、静脉通路淤滞、右向左分流、盲端、人工材料、房性心律失常以及高凝状态。为了明确血栓栓塞事件的特征、描述其发生频率和情况，并将这些事件的风险与患者、手术、血流动力学和血液学因素联系起来，人们进行了大量研究，其中大多数是回顾性研究。在Fontan手术后，为了尽量减少血栓栓塞的发生和发病，预防性抗凝策略的实施差异很大。文献综述表明，Fontan手术后与血栓栓塞事件相关的因素可能代表了一个具有多种相互作用的复杂生物学因素领域。单一药物不太可能解决这个复杂问题。
