{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:04Z","timestamp":1753876264277,"version":"3.41.2"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Fontan operation is a well-described palliative procedure for functional single-ventricle patients. This population has an increased risk of thrombo-embolic events. Adequate imaging, and therefore diagnosis, requires an understanding of the unique anatomy and physiology of a Fontan. Optimal strategies for the prevention and treatment of thrombo-embolic complications in the Fontan population are poorly defined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 28-year-old female with a history of Ebstein anomaly of the tricuspid valve status post-Fontan presented with chest pain and acute hypoxia. Computed tomographic angiography (CTA) reported a submassive pulmonary embolism (PE). She was initiated on a heparin drip. Catheterization demonstrated elevated Fontan pressures and a large thrombus in the right lower pulmonary artery that was removed with an aspiration device. The patient was transitioned to a direct oral anticoagulant (DOAC) following the procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Thrombotic complications are common in the adult Fontan population. Given the morbidity and mortality associated with this complication, the use of proper imaging techniques is imperative. Traditional CTA imaging for PE in Fontan patients often has contrast filling defects related to their anatomy and physiology. Utilization of adequate imaging techniques helps decrease cost and additional radiation exposure. In addition, it avoids inappropriate hospitalization, need for anticoagulation, and potential need for catheterization toconfirm or exclude the presence of PE. For Fontan patients with a thrombus, prior event, and no contraindications, current guidelines recommend oral anticoagulation with a vitamin K antagonist; however, there are increasing data on the use of DOACs in this population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad401","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T09:54:53Z","timestamp":1692611693000},"source":"Crossref","is-referenced-by-count":3,"title":["Transcatheter thrombectomy of acute pulmonary embolism in an adult Fontan patient: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-703X","authenticated-orcid":false,"given":"Christina","family":"Benjamin","sequence":"first","affiliation":[{"name":"Center for Heart Care, Phoenix Children\u2019s , 1919 E Thomas Rd, Phoenix, AZ 85016 , USA"},{"name":"Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne J","family":"Franklin","sequence":"additional","affiliation":[{"name":"Center for Heart Care, Phoenix Children\u2019s , 1919 E Thomas Rd, Phoenix, AZ 85016 , USA"},{"name":"Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"},{"name":"Department of Internal Medicine, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byron","family":"Garn","sequence":"additional","affiliation":[{"name":"Center for Heart Care, Phoenix Children\u2019s , 1919 E Thomas Rd, Phoenix, AZ 85016 , USA"},{"name":"Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan D","family":"Awerbach","sequence":"additional","affiliation":[{"name":"Center for Heart Care, Phoenix Children\u2019s , 1919 E Thomas Rd, Phoenix, AZ 85016 , USA"},{"name":"Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"},{"name":"Department of Internal Medicine, University of Arizona College of Medicine-Phoenix , Phoenix, AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"2023091408315733900_ytad401-B1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ahj.2016.09.014","article-title":"Prevalence and outcome of thrombotic and embolic complications in adults after Fontan operation","volume":"183","author":"Egbe","year":"2017","journal-title":"Am Heart J"},{"key":"2023091408315733900_ytad401-B2","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1016\/S0735-1097(03)00490-X","article-title":"Prevalence of \u201csilent\u201d pulmonary emboli in adults after the Fontan operation","volume":"41","author":"Varma","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"2023091408315733900_ytad401-B3","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00246-020-02417-9","article-title":"Optimized computed tomography angiography protocol for the evaluation of thrombus in patients with Fontan anatomy","volume":"41","author":"Boggs","year":"2020","journal-title":"Pediatr Cardiol"},{"key":"2023091408315733900_ytad401-B4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1111\/chd.12685","article-title":"Frontiers in Fontan failure: innovation and improving outcomes: a conference summary","volume":"14","author":"Ephrem","year":"2019","journal-title":"Congenit Heart Dis"},{"key":"2023091408315733900_ytad401-B5","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.jacc.2018.08.1028","article-title":"2018 AHA\/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines","volume":"73","author":"Stout","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2023091408315733900_ytad401-B6","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jacc.2022.10.037","article-title":"Thromboprophylaxis in patients with Fontan circulation","volume":"81","author":"Van den Eynde","year":"2023","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytad401\/51176768\/ytad401.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/9\/ytad401\/51550071\/ytad401.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/9\/ytad401\/51550071\/ytad401.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T14:40:58Z","timestamp":1694702458000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytad401\/7246549"}},"subtitle":[],"editor":[{"given":"Anastasia","family":"Egorova","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Andriana","family":"Anagnostopoulou","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Arif Anis","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Arvind","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Zhiyu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,21]]},"references-count":6,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytad401","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2023,9]]},"published":{"date-parts":[[2023,8,21]]},"article-number":"ytad401"}}