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Case report of percutaneous intervention for extensive thrombosis after the Fontan procedure in a 14-year-old
David Ferri-Rufete1, Juan Carretero Bellón1, Fredy Hermógenes Prada Martínez1
1Paediatric Cardiology Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
Insights
A novel device successfully removed a Fontan conduit thrombus in a patient with single-ventricle physiology, resolving complications like low cardiac output and organomegaly after extracardiac Fontan surgery.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Interventional Cardiology
Background:
- Thromboembolic complications are a major cause of morbidity after the Fontan procedure due to altered hemodynamics.
- Single-ventricle physiology presents unique challenges in managing post-Fontan complications.
Background:
Thromboembolic complications remain a significant cause of morbidity following the Fontan procedure, driven by the unique haemodynamics of the Fontan circulation.
Case Summary:
We present a case of a 14-year-old patient with single-ventricle physiology who underwent an extracardiac Fontan procedure. Post-operatively, he developed low cardiac output requiring extracorporeal membrane oxygenation (ECMO) support. Despite successful weaning from ECMO, hepatomegaly, pleural effusion, and ascites persisted. Further investigation revealed a significant thrombus within the Fontan conduit. Due to the high risks associated with systemic thrombolysis and repeat cardiac surgery, these treatment options were not pursued. Instead, an innovative approach utilizing a device specifically engineered for thrombus extraction in the pulmonary arteries was used. The conduit thrombus was completely extracted without complications, and the patient recovered rapidly and was discharged 2 weeks later.
Discussion:
This case highlights the potential complications following Fontan surgery and the importance of timely, tailored new therapeutic interventional procedures in fragile patients with complex congenital heart diseases.
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