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[Pulmonary thromboembolism after Fontan operation].
Fernando Benito Bartolomé1, Fredy Prada Martínez, Monserrat Bret Zurita
1Sección de Hemodinámica, Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain.
Revista Espanola De Cardiologia
|April 27, 2002
Summary
A Fontan operation complication led to fatal pulmonary artery thrombosis in a pediatric patient. Early recognition and treatment of thrombosis after Fontan surgery are crucial for improving outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
- This case involves an eleven-year-old girl with tricuspid atresia who previously underwent a Blalock Taussig shunt and bidirectional Glenn procedure.
- The extra-cardiac Fontan was performed using a fenestrated Dacron conduit.
Observation:
- The patient developed sudden cyanosis, dyspnea, chest pain, and syncope one month post-Fontan operation.
- Clinical presentation suggested left pulmonary artery thrombosis.
- Diagnostic imaging confirmed thrombosis without a right-to-left shunt across the fenestration.
Findings:
- Despite attempts at mechanical lysis and local rtPA infusion, the thrombosis was refractory to treatment.
- The patient experienced a fatal outcome three hours after intervention initiation.
- Anticoagulation management included low molecular weight heparin followed by aspirin.
Implications:
- This case highlights a rare but devastating complication of the Fontan procedure.
- It underscores the importance of vigilant monitoring for thromboembolic events post-Fontan surgery.
- Further research into optimal anticoagulation strategies and thrombosis management in Fontan patients is warranted.