Percutaneous coronary intervention following Fontan procedure

Area of Science:

• Cardiology
• Pediatric Cardiology
• Interventional Cardiology

Background:

• The Fontan procedure, a palliative surgery for complex congenital heart defects, is associated with a higher risk of thromboembolic events.
• Coronary artery thrombotic occlusion is an uncommon complication in Fontan patients.

Purpose of the Study:

• To report a rare case of acute coronary syndrome in a young patient with a history of Fontan procedure.
• To emphasize the importance of considering coronary artery thrombosis in Fontan survivors presenting with myocardial infarction.
• To highlight the need for multidisciplinary collaboration in managing such complex cases.

Main Methods:

• Case presentation of a 10-year-old boy with hypoplastic left heart syndrome and a Fontan procedure.
• Diagnosis of myocardial infarction secondary to left circumflex coronary artery thrombotic occlusion.
• Successful treatment with percutaneous coronary intervention (PCI), including thrombus aspiration, balloon angioplasty, and stent placement.

Main Results:

• The patient presented with symptoms of myocardial infarction.
• Coronary angiography revealed thrombotic occlusion of the left circumflex artery.
• Percutaneous coronary intervention was technically successful, restoring blood flow and relieving symptoms.

Conclusions:

• Coronary artery thrombotic occlusion, though rare, is a potential complication in Fontan procedure patients.
• Acute coronary syndrome in this population requires prompt diagnosis and intervention.
• Collaboration between congenital and adult cardiologists is crucial for optimal outcomes in young patients with Fontan circulation and acute coronary syndrome.