Key result
Surgical extracardiac conduit replacement successfully relieves severe calcific obstruction in an adult Fontan patient.
Why the study?
Conduit obstruction is a complication in patients with Fontan circulation that requires multimodality imaging for diagnosis and surgical planning.
Case Report (n=1)
Multimodality imaging is crucial for diagnosing extracardiac conduit obstruction in Fontan patients presenting with heart failure symptoms to ensure correct surgical planning.
Supports multimodal imaging for surgical planning in Fontan failure; hypothesis-generating and not yet practice-changing.
BACKGROUND: Conduit obstruction is a complication of patients with Fontan circulation. CASE SUMMARY: This case report describes a Fontan patient who presented with exertional dyspnea and bilateral peripheral edema. Echocardiography identified a hyperechogenic structure within the extracardiac conduit, leading to further investigations with computed tomography and cardiac magnetic resonance imaging. These studies confirmed severe conduit obstruction due to a calcific mass and demonstrated extensive collateral circulation. MANAGEMENT: After a multidisciplinary team discussion, surgical extracardiac conduit replacement was performed. Postoperatively, the patient developed a pleural effusion, managed with surgical drainage and octreotide treatment. DISCUSSION: Fontan failure could be due to many etiologies. Extracardiac conduit obstruction should be suspected in Fontan patients with heart failure symptoms and investigated with multimodality imaging techniques. TAKE-HOME MESSAGE: This case highlights the necessity of a differential diagnosis in Fontan failure patients and the need of multimodal imaging to reach definitive information necessary for a correct surgical planning.
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D’Angelo et al. (2025) conducted a case report in Fontan circulation with extracardiac conduit subocclusion (n=1). Surgical extracardiac conduit replacement was evaluated. Surgical extracardiac conduit replacement was performed in 1 adult Fontan patient with severe conduit obstruction due to a calcific mass, followed by postoperative pleural effusion.
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