title: Anticoagulation in children undergoing cardiac surgery.
abstract: Advances in medical and surgical care have resulted in improved survival of patients with congenital heart disease (CHD). Parallel to these progresses, an increasing number of immediate and long-term complications have been recognized. One important complication in CHD is the development of thrombosis. Children with a single functional cardiac ventricle usually require sequential steps of surgery: the initial Blalock-Taussig shunts (BTS) during the neonatal period, followed by the Glenn shunt, and finally, the Fontan shunt, the "definitive palliative" procedure. Surgery mostly involves cardiopulmonary bypass (CPB), which also affects the coagulation system and causes an inflammatory response. This article will review surgical procedures, such as BTS, Glenn shunt, and Fontan shunt, prosthetic mechanical valves, and CPB, and their risk of thrombotic complications. There is insufficient evidence and no consensus for optimal anticoagulant prophylaxis or treatment in children with CHD. Current recommendations are mostly based on adult data.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. katharina.thom@meduniwien.ac.at
authors.forename: Katharina E
authors.initials: KE
authors.lastname: Thom
authors.forename: Andreas
authors.initials: A
authors.lastname: Hanslik
authors.forename: Christoph
authors.initials: C
authors.lastname: Male
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000379:methods; D006328:Cardiac Catheterization / Q000187:drug effects / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D002648:Child; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin