Systemic Thrombolysis and Anticoagulation for Early Post-Fontan Thrombosis: A Five-Patient Case Series.
Sanketh Edem, Lasya Reddy, Anand Kumar Mishra et al.
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Case in brief
This retrospective series described five patients with imaging-confirmed venous thrombosis during the first postoperative week after Fontan completion. Each developed persistent fever with negative cultures between postoperative days 3 and 5. Thrombi involved the inferior vena cava in three patients, the iliac veins in one, and the extracardiac conduit in one. Three patients received systemic alteplase with unfractionated heparin; two received heparin alone. Fever resolved within 48 hours of treatment, and imaging showed complete venous recanalization within 2 to 3 days. No rethrombosis or major bleeding was reported during 3 to 6 months of follow-up.
What made this case unusual
Persistent, culture-negative fever was the shared presenting feature of early post-Fontan thrombosis, including thrombosis at several venous sites. Both thrombolysis with heparin and heparin alone were followed by recanalization in this series.
Diagnostic / clinical pearl
In a patient with recent Fontan surgery and persistent fever without an identified infection, evaluate for Fontan-pathway or venous thrombosis.