{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:20:30Z","timestamp":1777364430801,"version":"3.51.4"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951124000489_as1\"><jats:title>Objective:<\/jats:title><jats:p>Identifying thrombus formation in Fontan circulation has been highly variable, with reports between 17 and 33%. Initially, thrombus detection was mainly done through echocardiograms. Delayed-enhancement cardiac MRI is emerging as a more effective imaging technique for thrombus identification. This study aims to determine the prevalence of occult cardiac thrombosis in patients undergoing clinically indicated cardiac MRI.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951124000489_as2\"><jats:title>Methods:<\/jats:title><jats:p>A retrospective chart review of children and adults in the Duke University Hospital Fontan registry who underwent delayed-enhancement cardiac MRI. Individuals were excluded if they never received a delayed-enhancement cardiac MRI or had insufficient data. Demographic characteristics, native heart anatomy, cardiac MRI measurements, and thromboembolic events were collected for all patients.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951124000489_as3\"><jats:title>Results:<\/jats:title><jats:p>In total, 119 unique individuals met inclusion criteria with a total of 171 scans. The median age at Fontan procedure was 3 (interquartile range 1, 4) years. The majority of patients had dominant systemic right ventricle. Cardiac function was relatively unchanged from the first cardiac MRI to the third cardiac MRI. While 36.4% had a thrombotic event by history, only 0.5% (1 patient) had an intracardiac thrombus detected by delayed-enhancement cardiac MRI.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951124000489_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Despite previous echocardiographic reports of high prevalence of occult thrombosis in patients with Fontan circulation, we found very low prevalence using delayed-enhancement cardiac MRI. As more individuals are reaching adulthood after requiring early Fontan procedures in childhood, further work is needed to develop thrombus-screening protocols as a part of anticoagulation management.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951124000489","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T08:56:45Z","timestamp":1710925005000},"page":"1544-1549","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Detection of occult thrombosis in individuals with Fontan circulation by cardiac MRI"],"prefix":"10.1017","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2074-4714","authenticated-orcid":false,"given":"Samantha F.","family":"Curtis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariah","family":"Cicioni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandria","family":"Mullikin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Michael","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0949-3799","authenticated-orcid":false,"given":"Piers C. A.","family":"Barker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-4915","authenticated-orcid":false,"given":"Andrew W.","family":"McCrary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"S1047951124000489_ref4","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1016\/j.jacc.2016.06.056","article-title":"Thrombotic and embolic complications associated with atrial arrhythmia after Fontan operation: role of prophylactic therapy","volume":"68","author":"Egbe","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.amjcard.2003.09.023","article-title":"Incidence, outcome, and risk factors for stroke after the Fontan procedure","volume":"93","author":"Chun","year":"2004","journal-title":"Am J Cardiol"},{"key":"S1047951124000489_ref20","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1053\/pcsu.2002.29716","article-title":"Thromboembolic problems after the Fontan operation","volume":"5","author":"Monagle","year":"2002","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"key":"S1047951124000489_ref15","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S0894-7317(99)70097-0","article-title":"Improved echocardiographic delineation of left ventricular thrombus with the use of intravenous second-generation contrast image enhancement","volume":"12","author":"Thanigaraj","year":"1999","journal-title":"J Am Soc Echocardiogr"},{"key":"S1047951124000489_ref16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ahj.2005.08.021","article-title":"Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation","volume":"152","author":"Srichai","year":"2006","journal-title":"Am Heart J"},{"key":"S1047951124000489_ref7","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00246-007-9006-1","article-title":"Thromboembolism and the role of anticoagulation in the Fontan patient","volume":"28","author":"Jacobs","year":"2007","journal-title":"Pediatr Cardiol"},{"key":"S1047951124000489_ref2","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1177\/1076029613520464","article-title":"Thrombosis and thromboembolic complications in fontan patients: a literature review","volume":"20","author":"Firdouse","year":"2014","journal-title":"Clin Appl Thromb Hemost"},{"key":"S1047951124000489_ref3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ahj.2019.04.009","article-title":"Rivaroxaban, a direct factor Xa inhibitor, versus acetylsalicylic acid as thromboprophylaxis in children post-Fontan procedure: rationale and design of a prospective, randomized trial (the UNIVERSE study)","volume":"213","author":"Pina","year":"2019","journal-title":"Am Heart J"},{"key":"S1047951124000489_ref10","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"S1047951124000489_ref11","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"S1047951124000489_ref14","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1016\/S0735-1097(99)00420-9","article-title":"Epidemiological approach to quality assessment in echocardiographic diagnosis","volume":"34","author":"Berger","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref21","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jacc.2022.10.037","article-title":"Thromboprophylaxis in patients with Fontan circulation","volume":"81","author":"Van den Eynde","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref19","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0003-4975(01)03068-5","article-title":"Fontan\u2019s operation: is aspirin enough? Is coumadin too much?","volume":"73","author":"Jacobs","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"S1047951124000489_ref1","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/S0022-5223(00)70010-9","article-title":"Intracardiac thrombus formation after the Fontan operation","volume":"119","author":"Balling","year":"2000","journal-title":"J Thorac Cardiovasc Surg"},{"key":"S1047951124000489_ref12","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1161\/CIR.0000000000000696","article-title":"Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American heart association","volume":"140","author":"Rychik","year":"2019","journal-title":"Circulation"},{"key":"S1047951124000489_ref6","doi-asserted-by":"crossref","first-page":"e021765","DOI":"10.1161\/JAHA.120.021765","article-title":"Thromboprophylaxis for children post-Fontan procedure: insights from the UNIVERSE study","volume":"10","author":"McCrindle","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"S1047951124000489_ref18","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jacc.2019.07.021","article-title":"The Fontan thromboprophylaxis Dilemma","volume":"74","author":"Chugh","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref5","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/thx.26.3.240","article-title":"Surgical repair of tricuspid atresia","volume":"26","author":"Fontan","year":"1971","journal-title":"Thorax"},{"key":"S1047951124000489_ref13","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/0735-1097(91)90512-8","article-title":"Transesophageal echocardiography detects thrombus formation not identified by transthoracic echocardiography after the Fontan operation","volume":"18","author":"Fyfe","year":"1991","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jacc.2008.03.041","article-title":"Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction","volume":"52","author":"Weinsaft","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"S1047951124000489_ref9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40949-017-0010-x","article-title":"Role of cardiac MRI and CT in Fontan circulation","volume":"1","author":"Yeong","year":"2017","journal-title":"J Congenit Cardiol"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951124000489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T08:04:17Z","timestamp":1729843457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951124000489\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["S1047951124000489"],"URL":"https:\/\/doi.org\/10.1017\/s1047951124000489","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]},"assertion":[{"value":"\u00a9 The Author(s), 2024. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}