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Updated: Feb 24, 2026

Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Rudimentary Right Ventricle Thrombus Leading to Multifocal Stroke in Fontan Circulation
Presentation:
Patients with Fontan circulation are at increased risk of thromboembolism. We report a case of multifocal stroke caused by thrombus in a rudimentary right ventricle and highlight the need to consider stroke in Fontan patients with neurological symptoms.
Diagnosis:
A CT brain which presented normal. MRI/MRA brain performed demonstrating multifocal shower of infarcts consistent with an acute embolic cerebrovascular event. Transthoracic echo was normal. Transoesophageal echo located a thrombus within the trabeculations of the rudimentary right ventricle, confirming a diagnosis of thromboembolic stroke secondary to RV thrombus.
Treatment:
Multidisciplinary care including cardiology, neurology, and haematology. Commenced on anticoagulation with an INR target range of 2-3. Possible future catheter procedure to occlude right ventricle.
Discussion:
This case highlights the persistent risk of thromboembolic events in Fontan patients in whom residual cardiac structures such as a rudimentary ventricle can serve as a source of thrombus. Multimodal imaging is critical for diagnosis. Optimal thromboprophylaxis remains uncertain.
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