Warfarin-Aspirin Therapy in Congenitally Corrected Transposition of the Great Arteries After Lateral Tunnel Fontan.

BACKGROUND

Fontan circulation carries high risk of thromboembolic complications, and optimal anticoagulation strategies in pediatric patients remain controversial.

CASE SUMMARY: A 13-year-old adolescent boy with dextrocardia, congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis underwent staged surgical palliation including a bidirectional Glenn shunt followed by the lateral tunnel Fontan procedure. Postoperative echocardiography demonstrated a functioning Fontan circulation with reduced right ventricular systolic dysfunction and mild-to-moderate tricuspid regurgitation. The patient developed postoperative tachycardia (heart rate ∼150 beats/min), for which oral digoxin was initiated during hospitalization. Given the prothrombotic nature of Fontan physiology, long-term anticoagulation with warfarin, along with aspirin, was commenced, and over time, no thromboembolic events occurred during 6-month follow-up.

DISCUSSION: Patients with systemic right ventricles and Fontan physiology represent a high-risk subgroup for thrombosis. Individualized anticoagulation strategies are essential.

TAKE-HOME MESSAGE: Warfarin, along with aspirin, can be safely implemented in selected patients with high-risk Fontan.