Embolic stroke in a postpartum patient with Fontan physiology

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-222684
• Main Authors: VanHise, Katherine, Li, Linda, Smith, Emily, Condon, Niamh
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 05.01.2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Adult; Age; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Case reports; Childbirth & labor; Congenital diseases; Coronary vessels; Defects; Electrocardiography; Female; Fontan Procedure - adverse effects; Heart; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; Infarction, Middle Cerebral Artery - etiology; Obstetrics; Patients; Physiology; Postoperative Complications - etiology; Pregnancy; Puerperal Disorders - etiology; Pulmonary arteries; Rare Disease; Stroke; Thromboembolism; Womens health; obstetrics and gynaecology; stroke; cardiovascular medicine; pregnancy
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-222684

In cardiac physiology, single ventricle typically refers to the presence of a dominant systemic ventricle along with a hypoplastic ventricle. The Fontan operation is used to repair the single ventricle by directing deoxygenated systemic venous flow to the pulmonary arterial circulation. Normal pregnancy physiology, particularly increased intravascular volume, increased heart rate, increased cardiac output, hypercoagulability and decreased systemic vascular resistance, can exacerbate cardiac disease in patients with Fontan circulation, leading to pregnancy complications. Despite the known risks, there are limited data addressing the question of anticoagulation in pregnant patients with Fontan physiology. Herein we present the case of a Fontan patient who had a successful pregnancy and delivery, and developed an embolic stroke in the postpartum period.