Rudimentary Right Ventricle Thrombus Leading to Multifocal Stroke in Fontan Circulation.

PRESENTATION: Patients with Fontan circulation are at increased risk of thromboembolism. We report a case of multifocal stroke caused by thrombus in a rudimentary right ventricle and highlight the need to consider stroke in Fontan patients with neurological symptoms.

DIAGNOSIS: A CT brain which presented normal. MRI/MRA brain performed demonstrating multifocal shower of infarcts consistent with an acute embolic cerebrovascular event. Transthoracic echo was normal. Transoesophageal echo located a thrombus within the trabeculations of the rudimentary right ventricle, confirming a diagnosis of thromboembolic stroke secondary to RV thrombus.

TREATMENT: Multidisciplinary care including cardiology, neurology, and haematology. Commenced on anticoagulation with an INR target range of 2-3. Possible future catheter procedure to occlude right ventricle.

DISCUSSION: This case highlights the persistent risk of thromboembolic events in Fontan patients in whom residual cardiac structures such as a rudimentary ventricle can serve as a source of thrombus. Multimodal imaging is critical for diagnosis. Optimal thromboprophylaxis remains uncertain.