Extracardiac Conduit Subocclusion in an Adult Patient With a Fontan Circulation.

BACKGROUND

Conduit obstruction is a complication of patients with Fontan circulation.

CASE SUMMARY

This case report describes a Fontan patient who presented with exertional dyspnea and bilateral peripheral edema. Echocardiography identified a hyperechogenic structure within the extracardiac conduit, leading to further investigations with computed tomography and cardiac magnetic resonance imaging. These studies confirmed severe conduit obstruction due to a calcific mass and demonstrated extensive collateral circulation.

MANAGEMENT

After a multidisciplinary team discussion, surgical extracardiac conduit replacement was performed. Postoperatively, the patient developed a pleural effusion, managed with surgical drainage and octreotide treatment.

DISCUSSION

Fontan failure could be due to many etiologies. Extracardiac conduit obstruction should be suspected in Fontan patients with heart failure symptoms and investigated with multimodality imaging techniques.

TAKE-HOME MESSAGE: This case highlights the necessity of a differential diagnosis in Fontan failure patients and the need of multimodal imaging to reach definitive information necessary for a correct surgical planning.