Page 42 - Journal of Structural Heart Disease Volume 3, Issue 4

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Case Reports
Figure 1.
Figure 2. Schematic of the single ventricle anatomy after the Fontan operation.
the proximal pulmonary artery but no antegrade ow into the pulmonary arteries or Fontan circuit (Figure 3). Although no thrombus was appreciated within the pulmonary valve sinuses or proximal pul- monary artery, the patient was started on warfarin therapy. A follow-up echocardiogram two months later demonstrated a moderate-sized mobile throm- bus within the pulmonary stump despite an inter- national normalized ratio of 3.3. Although there was no evidence of systemic embolism, it was deemed necessary to proceed with obliteration of the pulmo- nary stump, as the presence of thrombus was felt to indicate failure of anticoagulation therapy. Because of the patient’s recent surgery and multiple prior pro- cedures, transcatheter obliteration was proposed.
At nearly 3 years of age and a weight of 18 kg, the patient proceeded to the cardiac catheterization lab- oratory. The procedure was performed under general anesthesia guided by transesophageal echocardiog-
Schematic of the single ventricle anatomy prior to surgical intervention.
and later closed spontaneously. At 6 months of age, via re-do sternotomy, the patient underwent shunt takedown and construction of a bidirectional Glenn anastomosis. The main pulmonary artery was not di- vided but was suture-ligated proximally. Follow-up echocardiography revealed persistent patency of the main pulmonary artery. At 30 months of age, via third-time sternotomy, an extracardiac Fontan opera- tion was performed using a 20-mm conduit. The main pulmonary artery was again suture-ligated but not di- vided, leaving a blind end pulmonary out ow stump (Figure 2).
An echocardiogram performed on post-operative day 5 demonstrated persistent to-and-from ow into
Rhodes, J. F. et al.
Transcatheter Pulmonary Value Stump Device Closure