Hepatic coma secondary to Fontan Conduit thrombosis

Authors

• 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

joaocavaco@fm.ul.pt

Keywords

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.

References