Embolic stroke in a postpartum patient with Fontan physiology

Area of Science:

• Cardiology
• Reproductive Medicine
• Vascular Surgery

Background:

• Single ventricle physiology often requires surgical repair via the Fontan operation, creating a unique circulatory pathway.
• Pregnancy significantly alters maternal physiology, increasing risks for patients with complex congenital heart disease like Fontan circulation.
• Limited evidence exists regarding optimal anticoagulation strategies for pregnant individuals with Fontan physiology.

Observation:

• A patient with Fontan circulation successfully completed a pregnancy and delivery.
• The patient experienced an embolic stroke in the postpartum period.
• This event occurred despite the known hypercoagulable state associated with pregnancy and Fontan physiology.

Findings:

• The case demonstrates a potential complication (embolic stroke) in the postpartum period for Fontan patients.
• Successful pregnancy outcomes are possible, but postpartum complications remain a concern.
• The need for careful management and consideration of anticoagulation is highlighted.

Implications:

• This case emphasizes the critical need for further research into anticoagulation management during and after pregnancy in Fontan patients.
• Developing evidence-based guidelines for anticoagulation in this population is crucial for improving maternal safety.
• Clinicians should maintain a high index of suspicion for thromboembolic events in the postpartum period for individuals with Fontan circulation.