Pulmonary Embolism, Thrombectomy, and Catheter-Directed Lysis in Pregnant Woman With Fontan Palliation

Patients with Fontan circulation are at increased risk for thrombosis, particularly during pregnancy.

A 26-year-old woman at 10 weeks gestation with a lateral tunnel Fontan experienced acute onset of dyspnea and dizziness. Cardiac CT demonstrated an occlusive pulmonary embolism within the Fontan circulation. The patient underwent pulmonary thrombectomy and catheter-directed thrombolysis without complications. A surveillance cardiac CT 3 months after her discharge demonstrated complete resolution of the thrombus, and the patient is at baseline functional capacity.

Patients with Fontan circulation and pregnancy have a heightened risk for both thromboembolism and bleeding; anticoagulation strategies are thus not standardized and are tailored to each individual's case.

To our knowledge, this is the first reported case of pulmonary embolism during the antepartum period in a patient with Fontan palliation who was subsequently treated with pulmonary thrombectomy and catheter-directed thrombolysis. Multimodality imaging evaluation was critical for rapid diagnosis and interventional planning.