Cobarro Lucía, Jiménez-Valero Santiago, Gutiérrez-Larraya Federico, Merino Carlos, Merás Pablo, Ruiz-Cantador José, Balbacid Enrique, Poveda Isabel D, Rosillo Sandra O, Caro-Codón Juan, Jurado-Román Alfonso, Moreno Raúl
Cardiology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain.
Pediatric Cardiology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain.
Int J Cardiol Congenit Heart Dis. 2024 Jun 4;17:100518. doi: 10.1016/j.ijcchd.2024.100518. eCollection 2024 Sep.
Obstructive complications in the Fontan circulation pose significant risks to affected patients. Traditional management strategies may be insufficient, necessitating innovative treatment approaches. This case report discusses the use of the FlowTriever Retrieval System for percutaneous aspiration thrombectomy in a patient with a history of Fontan procedure who developed conduit obstruction due to thrombus formation.
A 28-year-old male with a history of double inlet left ventricle and previous Fontan procedure presented with progressive dyspnea. Despite initial thrombectomy for high-risk pulmonary embolism, thrombi remained in the Fontan conduit and inferior vena cava. The patient remained hemodynamically unstable. Imaging confirmed thrombosis of the extracardiac conduit. An innovative percutaneous approach using the FlowTriever system successfully restored conduit flow and removed thrombus. Subsequent stenting addressed residual stenosis. Post-intervention, the patient showed remarkable clinical improvement. There were no procedure-related complications. He was discharged on an optimized anticoagulation regimen and remained asymptomatic during follow-up.
This case demonstrates the efficacy of the FlowTriever Retrieval System in managing complex thrombotic obstructions in Fontan circulation, which not only effectively resolved the obstruction but also maintained haemodynamic stability, thus highlighting its potential to enhance current treatment modalities for such congenital heart conditions.
Fontan循环中的梗阻性并发症对受影响的患者构成重大风险。传统的管理策略可能不足，需要创新的治疗方法。本病例报告讨论了在一名有Fontan手术史、因血栓形成导致导管梗阻的患者中使用FlowTriever Retrieval System进行经皮抽吸血栓切除术。
一名有双入口左心室病史且曾接受Fontan手术的28岁男性出现进行性呼吸困难。尽管最初因高危肺栓塞进行了血栓切除术，但血栓仍留在Fontan导管和下腔静脉中。患者血流动力学仍不稳定。影像学检查证实心外导管血栓形成。使用FlowTriever系统的创新经皮方法成功恢复了导管血流并清除了血栓。随后的支架置入解决了残余狭窄问题。干预后，患者临床症状显著改善。无手术相关并发症。他出院时接受了优化的抗凝方案，随访期间无症状。
本病例证明了FlowTriever Retrieval System在处理Fontan循环中复杂血栓性梗阻方面的有效性，该系统不仅有效解决了梗阻问题，还维持了血流动力学稳定性，从而突出了其增强此类先天性心脏病当前治疗方式的潜力。
