[A case of the emergency salvage from the thrombotic occlusion of the Fontan conduit in tricuspid atresia].

The thrombotic occlusion of the Fontan conduit is one of the most fatal complications after Fontan procedure. Its survival case by the successful emergency surgery is reported. A 17-year-old male who had undergone Fontan procedure three years before for tricuspid atresia, using the expanded PTFE graft of 19 mm in internal diameter, had several episodes of palpitation due to probable paroxysmal atrial fibrillation. He suddenly complained chest oppression feeling and suffered paroxysmal atrial tachycardia following after atrial fibrillation. The radionuclide angiocardiography was performed immediately, which revealed clearly that the Fontan conduit had occluded by the thromboembolism in spite of the prophylactic anticoagulant therapy. Then the emergency surgery was performed successfully, in which the occluded Fontan conduit was replaced with another expanded PTFE graft of 20 mm in internal diameter under the extracorporeal circulation. It seemed that the inducement of this thrombotic occlusion of the Fontan conduit was paroxysmal atrial fibrillation. We emphasize the importance of the prevention of arrhythmias in the postoperative care of the Fontan procedure. Additionally we do emphasize the usefulness of the radionuclide angiocardiography which is available and non-invasive. Especially, first-pass study is much informative to elucidate the circulatory states in the cardiac anomalies.