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Infected thrombus in a Fontan circulation

Juan Francisco Fritche-Salazar1, Gabriela Meléndez-Ramírez2, José Antonio Arias-Godínez1

  • 1Echocardiography Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.

Echocardiography (Mount Kisco, N.Y.)
|December 4, 2020
PubMed

Insights

The Fontan operation, a palliative treatment for single-ventricle heart defects, has poor long-term outcomes. Patients often develop complications like liver disease, heart failure, and arrhythmias within 10 years, requiring ongoing monitoring.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Cardiovascular Surgery

Background:

  • The Fontan operation is a palliative surgical procedure for univentricular heart physiology, established in 1968.
  • Long-term outcomes following the Fontan operation are historically poor, with significant morbidity.
  • A substantial proportion of patients develop complications within a decade of the procedure.

Purpose of the Study:

  • To summarize the natural history and common complications associated with the Fontan operation.
  • To highlight the diagnostic modalities used for evaluating Fontan-associated morbidities.
  • To emphasize the importance of clinical and imaging follow-up in managing these patients.

Main Methods:

  • Review of the natural history and outcomes of patients undergoing the Fontan operation.
  • Identification of common complications, including tachyarrhythmias, liver disease, protein-losing enteropathy, heart failure, thrombosis, and infective endocarditis.
  • Discussion of diagnostic tools such as echocardiography and magnetic resonance imaging (MRI).

Main Results:

  • By 10 years post-Fontan operation, most patients experience at least one complication.
  • Complications encompass a wide spectrum, including cardiac, hepatic, gastrointestinal, and thromboembolic events.
  • Echocardiography and MRI are primary imaging techniques for complication detection.

Conclusions:

  • The Fontan operation, while life-extending, is associated with significant long-term complications.
  • Regular clinical assessment and advanced imaging are crucial for early detection and management.
  • Ongoing surveillance is essential for improving the quality of life and outcomes for Fontan patients.

Keywords:
cardiac surgerycongenital heart diseaseechocardiographyinfective endocarditismagnetic resonance imagingthrombus

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