CTICasesThrombosed Lateral Tunnel Fontan Palliation
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Imaging findings
Prior year's CTA with delayed imaging demonstrated a patent Fontan circulation, including a Glenn shunt and lateral tunnel Fontan. Current CTA, performed for worsening heart failure, shows an open Glenn shunt but unopacified lateral tunnel Fontan on arterial phase. Delayed imaging confirms complete thrombosis of the lateral tunnel Fontan. The Fontan palliation was a revised system that bypassed the hepatic veins, anastomosing to the IVC below the hepatic veins, with the hepatic IVC draining into the right atrium, which had communication with the left atrium.
Key takeaways
Thrombosis of a Fontan circuit is a serious complication in patients with single-ventricle physiology, leading to worsening heart failure symptoms. Delayed imaging on CTA is critical for assessing Fontan patency, as arterial phase imaging alone may be misleading due to complex hemodynamics and slow flow. Congenital heart disease patients with complex surgical palliation require careful imaging evaluation for complications.
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