• Massimiliano Cantinotti, Raffaele Giordano, Pietro Marchese, Eliana Franchi, Cecilia Viacava, Vitali Pak, Bruno Murzi, Luigi Arcieri, Vincenzo Poli, Duccio Federici, Martin Koestenberger, and Nadia Assanta.
• Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology, National Research Institute, Pisa, Italy.
• J. Cardiothorac. Vasc. Anesth. 2020 Apr 1; 34 (4): 951-955.

ObjectivesBleeding is a common, serious, and often subtle complication after total cavopulmonary connection surgery. The aim of the present study was to assess the incidence of retrosternal clots after surgery, which were searched for systematically with transthoracic ultrasound.DesignRetrospective study.SettingSingle center.ParticipantsTotal cavopulmonary surgeries were reviewed from January 2016 to May 2019.InterventionsThoracic ultrasound with careful evaluation of the retrosternal area was performed at different postoperative times (12-36 hours, 5-7 days, and before discharge) as completion of routine echocardiography.Measurements And Main ResultsAmong 37 children undergoing total cavopulmonary 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 clots (<1 cm), 2 (5.4%) small to moderate sized clots (>1 cm-<2 cm), 3 (8.1%) moderate sized clots (>2-<3 cm), and 6 (16.2%) large clots (>3 cm). Four of the 6 detected large clots required surgical revision, and in the other 2 patients, the clots were not treated because the patients' conditions were clinically stable. When 3 major groups (group 1-no or small clots, group gropu 2 are small to moderate or moderate, group 3-large clots) were evaluated, no significant differences were noted in age, body surface area, CPB time, conduit type, or the number of previous surgeries.ConclusionsWith thoracic ultrasound diagnosis, existence of retrosternal clots was found to be very common after total cavopulmonary connection. Most clots were small or moderate with no clinical effect; however, large clots that required redo surgery also were detected.Copyright © 2019 Elsevier Inc. All rights reserved.

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