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[A right atrial thrombus after Fontan procedure--a case report]
K Hayashi1, K Suma, Y Takeuchi
1Department of Cardiovascular Surgery, Tokyo Women's Medical College 2nd Hospital, Japan.
Insights
A modified Fontan procedure patient died from heart failure due to a right atrial appendage thrombus. Excising the appendage, anticoagulation, and regular echocardiography are recommended after this surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The modified Fontan procedure is a palliative surgical option for complex congenital heart defects like tricuspid atresia.
- Maintaining long-term patency and preventing thromboembolic complications are critical challenges following Fontan procedures.
Observation:
- A 17-year-old male with tricuspid atresia developed fatal heart failure 4.5 years post-modified Fontan operation.
- Autopsy revealed a significant thrombus within the right atrial appendage, identified as the likely cause of death.
Findings:
- Thrombus formation in the right atrial appendage is a potential and serious complication after modified Fontan procedures.
- The presence of the atrial appendage may contribute to thrombus development and subsequent adverse events.
Implications:
- Surgical excision of the right atrial appendage during modified Fontan procedures may reduce the risk of thromboembolism.
- Postoperative anticoagulation therapy and regular echocardiographic monitoring are crucial for early detection of thrombus formation.
- These findings highlight the importance of vigilant management strategies to improve long-term outcomes for Fontan patients.
Abstract:
A 17-year-old male with tricuspid atresia who underwent a modified Fontan procedure died due to heart failure 4 years and 6 months after operation. At autopsy a thrombus was found in the right atrial appendage. From the experience, it might be recommended to excise the appendage when the modified Fontan procedure leaving the appendage was employed. In addition, anticoagulation therapy as well as regular echocardiographic examination for detecting thrombus formation should be considered after the operation.