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January 1967

Preoperative Correction of Coagulation in Tetralogy of Fallot

Author Affiliations

From the departments of medicine (Drs. von Kaulla and Wasantapruek and Mrs. von Kaulla) and surgery (Drs. Paton and Rosenkrantz), University of Colorado Medical Center, Denver.

Arch Surg. 1967;94(1):107-111. doi:10.1001/archsurg.1967.01330070109022

THIS preliminary report presents new information concerning the hemorrhagic diathesis which develops frequently in polycythemic, cyanotic patients with tetralogy of Fallot.1 Practical suggestions are offered for its prevention.

Unusual and excessive bleeding during and after surgery has been noticed since the earliest patients were operated upon for cyanotic congenital heart disease.2 This bleeding diathesis may become manifest during any type of surgery,3 but is particularly likely to occur in secondary cardiac operations.4 Although laboratory evidence of clotting deficiencies may be found in small children, severe bleeding is clinically much commoner in adolescents and adults.1 In secondary operations, the presence of vascular adhesions and extensive subcutaneous capillaries accentuates the problem.4

Various attempts to define the underlying clotting disturbances have been reported.5 Thrombocytopenia,6 low activity of the prothrombin complex,7 and poor clot retraction8 have been the most frequently seen abnormalities. Abnormal thromboplastin

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