Case report of percutaneous intervention for extensive thrombosis after the Fontan procedure in a 14-year-old

Thromboembolic complications remain a significant cause of morbidity following the Fontan procedure, driven by the unique haemodynamics of the Fontan circulation.

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.

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.