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  • Open Access

    REVIEW

    Heparin-induced thrombocytopenia complicating children after the Fontan procedure: Single-center experience and review of the literature

    Uri Pollak1,2,3, David Mishaly3,4, Gili Kenet3,5, Amir Vardi1,3

    Congenital Heart Disease, Vol.13, No.1, pp. 16-25, 2018, DOI:10.1111/chd.12557

    Abstract Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin therapy. The risk for HIT correlates with the cumulative dosage of heparin exposure. In Fontan patients, recurrent systemic anticoagulation, traditionally with heparin, is used to alleviate the thrombotic complications that may occur postoperatively when the venous pressure rises and the systemic venous flow into the pulmonary arteries becomes sluggish, putting them at increased risk. As a pressure gradient-dependent circulation, elevation in systemic venous pressure, most often by venous thrombosis, contributes to circuit failure. Therefore, when HIT complicates patients after the Fontan procedure, it is associated with More >

  • Open Access

    ARTICLE

    Transfusion‐related acute hepatic injury following postoperative platelets administration in pediatric patients undergoing the Fontan procedure

    Uri Pollak1,2,3,4,*, Tatyana Ruderman5,*, Sharon Borik‐Chiger5,6, David Mishaly5,7, Alain Serraf5,7, Amir Vardi5,8

    Congenital Heart Disease, Vol.14, No.6, pp. 968-977, 2019, DOI:10.1111/chd.12825

    Abstract Objective: The final common pathway of single ventricle patients is the Fontan procedure. Among the immediate postoperative complications is acute hepatic injury presented by marked elevation of liver enzymes (alanine transaminase [ALT] and aspartate transaminase [AST]). We aimed to determine the contribution of blood products transfusion to acute hepatic injury.
    Design: Single center retrospective cohort study.
    Setting: Pediatric Cardiac Intensive Care Unit at a tertiary medical center.
    Patients: Ninety‐nine pediatric patients undergoing the Fontan procedure between January 2009 and December 2016.
    Interventions: None.
    Measurements and Main Results: Out of the four types of blood products, transfusion of platelets was found to… More >

  • Open Access

    ARTICLE

    Creatinine‐based estimation of glomerular filtration rate in patients with a Fontan circulation

    Thomas G. Wilson1,2, Yves d’Udekem1,2,3, David S. Winlaw4,5, Rachael L. Cordina5,6, Julian Ayer4,5, Thomas L. Gentles7, Robert G. Weintraub1,2,8, Leeanne E. Grigg9, Michael Cheung1,8, Timothy M. Cain10, Padma Rao10, Charlotte Verrall4, Karin Du Plessis1, Kathryn Rice7, Ajay J. Iyengar1,3

    Congenital Heart Disease, Vol.14, No.3, pp. 454-463, 2019, DOI:10.1111/chd.12746

    Abstract Background: Patients with a Fontan circulation are at risk of renal dysfunction. We analyzed cross‐sectional data in pediatric and adult Fontan patients in order to assess the accuracy of commonly used serum creatinine‐based methods in estimating glo‐ merular filtration rate (GFR). Methods: A total of 124 Fontan patients (58 children, 66 adults) were enrolled across three study centers. Measurement of GFR (mGFR) using in vivo 99mTc‐DTPA clear‐ ance was performed. Various serum creatinine‐based equations were used to calcu‐ late estimated GFR (eGFR). Results: Mean mGFR was 108 ± 28 mL/min/1.73 m2 in children and 92 ±… More >

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