Extracardiac Conduit Subocclusion in an Adult Patient With a Fontan Circulation.

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.