Hepatic coma secondary to Fontan Conduit thrombosis
  • João Luís Cavaco
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • Ana Rita Ferreira
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • Constança Abecasis Jalles
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • Inês Matias Lopes
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • Armando Braz
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • Ana Oliveira Pedro
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
  • António Pais de Lacerda
    Department of Internal Medicine II, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal

Keywords

Fontan circulation, Fontan-associated liver disease, hepatic encephalopathy

Abstract

Introduction: The Fontan procedure is used to treat congenital heart defects and has improved long-term survival. Long-term complications include liver disease due to congestive hepatopathy. Fontan-related cirrhosis can manifest with ascites, gastrointestinal bleeding and encephalopathy.

Case description: A 43-year-old man with history of Fontan surgery was admitted with COVID-19 pneumonia. There was rapid clinical and neurological deterioration, with coma and shock. CT imaging showed thrombosis of the Fontan conduit. The patient was successfully subjected to recanalization of the Fontan circulation, with progressive improvement of coma.

Discussion: Fontan-associated liver disease is a major complication following the Fontan procedure. Clinicians must be aware of this pathology during patient follow-up.

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References

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  • Emamaullee J, Zaidi AN, Schiano T, Kahn J, Valentino PL, Hofer RE, et al. Fontan-associated liver disease: screening, management, and transplant considerations. Circulation 2020;142:591–604. doi: 10.1161/CIRCULATIONAHA.120.045597. PMID: 32776846; PMCID: PMC7422927.
  • Gordon-Walker TT, Bove K, Veldtman G. Fontan-associated liver disease: a review. J Cardiol 2019;74:223–232. doi: 10.1016/j.jjcc.2019.02.016. PMID: 30928109.

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    Published: 2023-04-06
    Issue: 2023: Vol 10 No 4 (view)

    How to cite:
    1.
    Cavaco JL, Ferreira AR, Abecasis Jalles C, Matias Lopes I, Braz A, Oliveira Pedro A, Pais de Lacerda A. Hepatic coma secondary to Fontan Conduit thrombosis. EJCRIM 2023;10 doi:10.12890/2023_003817.

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