Important complications of the Fontan procedure: Focus on thrombosis

Tóm tắt

Background

There is an ever-increasing number of patients with congenital heart disease who survive with single ventricle. These patients will need lifelong medical care, frequently with serious complications arising, that need to be closely monitored and treated. This case presentation aims to focus on thrombosis as one of the important complications of the Fontan procedure.

Methods

An 11-year old boy was admitted to the emergency room with chief complaint of swelling in the face and eyes since two weeks before admission. Swelling appeared suddenly and accompanied with bluer lips than usual. Patient previously underwent BCPS in 2012 and Fontan surgery in 2014. On physical examination, peripheral oxygen saturation was 87% with cyanosis at the lips. Heart examination revealed single second heart sound and pansystolic murmur 2/6 at lower left sternal border. Echocardiographic examination revealed sluggish flow at inferior vena cava and spontaneous echo contrast was seen. Multi- Slice Computed Tomography scan revealed thrombus at distal superior vena cava, right pulmonary artery, and extracardiac conduit Fontan. Patient was immediately started on warfarin. Two days later, during pediatric surgical conference, patient was decided for immediate thrombosuction. During catheterization, there was slow flow in the conduit and no thrombus was seen.

Results

Patient was discharged with stable hemodynamic condition and warfarin was continued.

Conclusion

Management of thrombosis as one of the important Fontan procedure complications is vital to reduce morbidity and mortality of patients. Both antiplatelet and anticoagulant can be given for patients with Fontan circulation. Consideration for risk factors, patient compliance, socioeconomic, as well as geographic conditions should be given.