Tedla Bruke A, Kim Yuli Y, Kobayashi Taisei, Fiorilli Paul N, Giri Jay S, Burke Megan, Partington Sara L, Abraham Boban P, Vaiyani Danish, Vaikunth Sumeet S
Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Case Rep. 2025 Jun 25;30(16):103959. doi: 10.1016/j.jaccas.2025.103959.
Patients with Fontan circulation are at increased risk for thrombosis, particularly during pregnancy.
A 26-year-old woman at 10 weeks gestation with a lateral tunnel Fontan experienced acute onset of dyspnea and dizziness. Cardiac CT demonstrated an occlusive pulmonary embolism within the Fontan circulation. The patient underwent pulmonary thrombectomy and catheter-directed thrombolysis without complications. A surveillance cardiac CT 3 months after her discharge demonstrated complete resolution of the thrombus, and the patient is at baseline functional capacity.
Patients with Fontan circulation and pregnancy have a heightened risk for both thromboembolism and bleeding; anticoagulation strategies are thus not standardized and are tailored to each individual's case.
TAKE-HOME MESSAGES: To our knowledge, this is the first reported case of pulmonary embolism during the antepartum period in a patient with Fontan palliation who was subsequently treated with pulmonary thrombectomy and catheter-directed thrombolysis. Multimodality imaging evaluation was critical for rapid diagnosis and interventional planning.
接受Fontan循环手术的患者发生血栓形成的风险增加，尤其是在妊娠期间。
一名妊娠10周、接受侧隧道Fontan手术的26岁女性，突发呼吸困难和头晕。心脏CT显示Fontan循环内存在闭塞性肺栓塞。患者接受了肺血栓切除术和导管定向溶栓治疗，未出现并发症。出院3个月后的心脏CT监测显示血栓完全溶解，患者功能能力恢复至基线水平。
接受Fontan循环手术且怀孕的患者发生血栓栓塞和出血的风险均升高；因此，抗凝策略未标准化，而是根据每个患者的具体情况进行调整。
据我们所知，这是首例报道的Fontan姑息治疗患者在产前发生肺栓塞，随后接受肺血栓切除术和导管定向溶栓治疗的病例。多模态影像评估对于快速诊断和介入治疗规划至关重要。
