Transcatheter Management of Native Aortic Root Thrombus After Fontan Palliation in a Pediatric Patient With COVID-19

Primary native aortic root thrombus is a rare complication after single-ventricle palliation.

We describe a case of a pediatric patient with a single ventricle who developed a native aortic root thrombus and coronary artery thrombi after undergoing Fontan palliation and following COVID-19 infection. This report describes the transcatheter techniques employed to manage the thrombi, as well as the management of an unexpected complication involving thrombus embolization to the left common iliac artery.

Native aortic root thrombus and coronary artery thrombi in single-ventricle patients are potentially fatal events that require urgent intervention. Transcatheter procedures for thrombus resolution are inherently high risk and demand meticulous risk-reduction strategies.

Risk of thrombotic complications may be higher in Fontan patients with COVID-19 infection. Timely use of high-risk procedural strategies in a single-ventricle patient with intracardiac and coronary artery thrombosis may be necessary to avoid lethal complications.