Evaluation of the Extracardiac Conduit Modification of the Fontan Operation for Thrombus Formation using Magnetic Resonance Imaging

Takawira, Farirai; Ayer, Julian G.; Onikul, Ella; Hawker, Richard E.; Kemp, Allan; Nicholson, Ian A.; Sholler, Gary F.

doi:10.1016/j.hlc.2008.01.001

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Volume 17, Issue 5 , Pages 407-410, October 2008

Evaluation of the Extracardiac Conduit Modification of the Fontan Operation for Thrombus Formation using Magnetic Resonance Imaging

Farirai Takawira, FCPaed
- The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Sydney, Australia
Julian G. Ayer, FRACP
- The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Sydney, Australia
- Corresponding author at: The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead NSW 2145, Sydney, Australia. Tel.: +61 2 98452345; fax: +61 2 98452163.
Ella Onikul, FRANZCR
- Medical Imaging, The Children's Hospital at Westmead, Sydney, Australia
Richard E. Hawker, FRACP
- The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Sydney, Australia
Allan Kemp, Cert Diag Rad
- Medical Imaging, The Children's Hospital at Westmead, Sydney, Australia
Ian A. Nicholson, FRACS
- The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Sydney, Australia
Gary F. Sholler, FRACP
- The Adolph Basser Cardiac Institute, The Children's Hospital at Westmead, Sydney, Australia

Received 4 March 2007; received in revised form 25 November 2007; accepted 10 January 2008.

Background

The prevalence of thrombosis after the Fontan procedure depends upon the surgical technique used and the method of detection employed. Current investigations for thrombosis lack sensitivity and specificity or, in the paediatric population, require a general anaesthetic. We undertook a study to examine the feasibility of using magnetic resonance imaging (MRI) to detect thrombosis within the conduit, cardiac chambers and pulmonary arteries after the extracardiac conduit modification of the Fontan procedure.

Methods

Of the 50 children who had undergone this procedure at our institution between 1997 and 2002, 26 were eligible for, and 13 underwent, MRI study. The mean age was 10.2 years (range 8.2–16.8 years, median 9.5 years) and the average time from operation was 63 months (range 29–79 months, median 68 months). The mean age at Fontan operation was 4.9 years (range 2.1–10.5 years). Ten were on low dose aspirin, two were on warfarin and one was not anti-coagulated. In all cases, satisfactory imaging of the venous pathways and pulmonary arteries was obtained and there were no thrombi detected.