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Successful percutaneous re-permeabilization of Fontan circuit with stent implantation after conduit thrombosis
Session:
Posters (Sessão 3 - Écran 7) - Intervenção em cardiopatias congénitas
Speaker:
Maria Ana Estevens
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.4 Congenital Heart Disease – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Maria Ana Ribeiro Estevens; Isabel Sampaio Graça; Miguel Mata; Mariana Lemos; Duarte Martins; Rui Anjos
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The Fontan circuit predisposition for thromboembolic complications is multifactorial and<sup> </sup>accounts for significant morbidity and mortality.<sup> </sup>Poor survival after thromboembolic complications has been reported, with mortality rates as high as 25% in pediatric series and 38% in adult series. We report two cases of Fontan conduit thrombosis treated by percutaneous stenting. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patient A, male, 43 years-old, with history of right isomerism with complete atrioventricular septal defect and hypoplastic left ventricle, underwent Fontan procedure with extracardiac conduit at age 15. He presented to ED with <span style="color:black">epigastric pain, nausea, syncope and hypoxemia. Echocardiography and angio-CT confirmed conduit thrombosis. Shortly thereafter he developed portosystemic encephalopathy and cardiogenic shock with need for mechanical ventilation and ICU admission. Conduit replacement surgery was deemed of too high-risk. Conduit re-permeabilization</span>, with tandem implantation of 4 stents in the IVC-PA conduit, covering from distal to proximal ends, was performed. A 45mm CP covered stent, two 39 mm CP covered stents and a 45 mm CP bare stent were implanted and dilated to 22mm, with final absence of gradient in the Fontan system. The patient recovered and was discharged home after 17 days. At 9 months follow-up he is asymptomatic with patent conduit. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patient B, male, 15 years-old, with history of double inlet left ventricle and transposition of the great arteries submitted to Fontan procedure, with extracardiac conduit implanted at 6 years of age. At age 15, on routine follow-up echocardiogram, thrombosis of the conduit with a 50% stenosis was diagnosed. He was asymptomatic and under anticoagulation with warfarin. Extensive thrombosis of the conduit was confirmed by MRI. Surgical replacement of the conduit was considered, but due to subacute and organized nature of the thrombus percutaneous intervention was attempted. Conduit dilation with a Mullins 18/40mm balloon was followed by implantation of two covered 45 mm CP stents. The procedure was successful, with no residual gradient in the conduit and the patient was discharged after 2 days. At 6 months follow up, he maintains a patent conduit with no residual thrombus. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In conclusion, conduit thrombosis is amenable to percutaneous stenting, which is an effective and safe option for re-permeabilization. </span></span></span></p>
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