Retrosternal clots after Fontan operation by systematic evaluation with transthoracic ultrasound

Abstract Objective Bleeding is a frequent, serious and often subtle complication after total cavo-pulmonary connection operation. The aim of our work was to assess the incidence of retrosternal clots after operation, which were systematically searched with transthoracic ultrasound. Design Retrospective study Setting Single center Participants We reviewed total cavo-pulmonary surgical series, from January 2016 to May 2019. Interventions thorax ultrasound with careful evaluation of the retrosternal area is performed at different post-operative times (12-36 hours, 5-7 days, and before discharge), as completion of routine echocardiography. Measurements and Main Results Among 37 children undergoing total cavo-pulmonary connection (mean age 5.5±1.8 years, range 2.4-11.7; mean body surface area 0.7±0.1 m2 (range 0.3-1.6 m2), retrosternal clots were detected in 18 (48.6%). Of these 7 (13.5%) had small ( 1 cm- 2- 3 cm). Four out of the 6 detected large clots required surgical revision, the other 2 cases were not treated since they were clinically stable. When 3 major groups (Group-1, no or small clots, Group 2 moderate clots, Group-3 large clots) were evaluated no significant differences were noted in age, body surface area, cardiopulmonary bypass time, conduit type, and the number of previous surgeries. Conclusions With thorax ultrasound diagnosis existence of retrosternal clots was found to be very common after total cavo-pulmonary connection. Most clots were small or moderate with no clinical impact, however large clots that require re-operation are also detected.