Thrombus formation can be a significant cause for morbidity and mortality after Fontan operation. Intracardiac thrombus formation can lead to chronic pulmonary embolic disease if formed on the right side, or stroke, if on the left side of the heart. Right-sided embolism may result in ventilation/perfusion mismatch or elevation of pulmonary vascular resistance, both of which may seriously hamper cavopulmonary physiology. We report the case of a 22-year-old patient, with past history of classic Fontan procedure performed at the age of six to palliate a single-ventricle tricuspid atresia, who presented with a massive pulmonary embolism and hemodynamic instability. Due to his critical status, mechanical fragmentation of the clot using the angiography catheter was started, followed by a local catheter-directed infusion of urokinase. This case demonstrated that pharmacomechanical thrombolysis therapy with a standard Pig-tail catheter and thrombolytic therapy with urokinase is secure, effective, and appropriated to manage heart chamber and pulmonary arterial thrombosis in patients with congenital heart disease.

译文

血栓形成可能是Fontan手术后发病率和死亡率的重要原因。如果在右侧形成心内血栓形成,则可导致慢性肺栓塞疾病,如果在心脏左侧形成,则可导致中风。右侧栓塞可能导致通气/灌注不匹配或肺血管阻力升高,这两种情况都可能严重阻碍腔肺生理。我们报告了一名22岁的患者的病例,该患者过去曾在6岁时进行过经典的Fontan手术,以缓解单心室三尖瓣闭锁,该患者出现大量肺栓塞和血流动力学不稳定。由于他的危急状态,开始使用血管造影导管对血块进行机械碎裂,然后进行局部导管定向的尿激酶输注。该病例表明,使用标准猪尾导管进行药物机械溶栓治疗和使用尿激酶进行溶栓治疗是安全,有效的,并且适合管理先天性心脏病患者的心脏腔和肺动脉血栓形成。

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