Percutaneous catheter aspiration thrombectomy for the occluded stents of pulmonary artery in children with single ventricle physiology after fontan surgery

Abstract

Successful surgical palliation with the Fontan procedure allows survival into adulthood for many patients born with single ventricle (SV) physiology, but the limited studies reported incidence of perioperative and long-term complications including thromboembolic events. Chronic pulmonary embolism is a common complication in patients with Fontan circulation, and may have serious consequences. Percutaneous intervention may be less invasive option for such a high-risk population than surgery is. We described two patients who developed complete thrombosis of the left pulmonary artery following catheter placement of a stent in this vessel shortly after Fontan surgery. Percutaneous catheter aspiration thrombectomy was successfully performed. Percutaneous catheter aspiration thrombectomy may be considered as a viable option in acute thrombus in children with SV physiology after Fontan surgery.

Hybrid approach to the comprehensive stage II operation in a subset of single-ventricle variants

“…LPA thrombosis following single-ventricle palliation is well described. [8][9][10] We speculate that delayed heparinization may have led to early thrombosis, and we now recommend use of a noncovered stent and early anticoagulation.…”

Thromboprophylaxis strategies for children with single-ventricle circulations (superior or total cavo-pulmonary connections) after stent implantation

“…Indeed, a case report by Hirono et al describes post-stent pulmonary artery thrombosis in two patients who underwent left pulmonary artery stent implantation shortly after the Fontan operation. 19 Nonetheless, there is a paucity of data regarding the issue of thromboprophylaxis post-stent in the asymptomatic patient with Glenn or Fontan circulation.…”

Treatment of Inferior Vena Cava Obstruction Following Pediatric Liver Transplantation: Novel Use of a Customized Endovascular Stent

“…19 Owing to the rarity of stent therapy for post-liver transplantation vascular complications, quantifying the exact incidence of morbidity and mortality resulting from thrombotic complications is difficult. Nonetheless, the serious morbidity associated with instent thrombosis in other populations 20,21 should motivate providers to minimize this risk in pediatric liver transplantation recipients if possible.…”