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Pulmonary Embolism, Thrombectomy, and Catheter-Directed Lysis in Pregnant Woman With Fontan Palliation
Journal article   Open access   Peer reviewed

Pulmonary Embolism, Thrombectomy, and Catheter-Directed Lysis in Pregnant Woman With Fontan Palliation

Bruke A. Tedla, Yuli Y. Kim, Taisei Kobayashi, Paul N. Fiorilli, Jay S. Giri, Megan Burke, Sara L. Partington, Boban P. Abraham, Danish Vaiyani and Sumeet S. Vaikunth
JACC. Case reports, v 30(16), 103959
25 Jun 2025
DOI: https://doi.org/10.1016/j.jaccas.2025.103959
PMID: 40579112
url
https://doi.org/10.1016/j.jaccas.2025.103959View
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Abstract

3-dimensional imaging echocardiography Fontan right-sided catheterization thrombus Congenital Heart Disease
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. 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. [Display omitted]

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