Work

Transcatheter Occlusion of Hepatic Vein-Atrial Communication After Modified Fontan in a Child Post Kawashima Surgery

Year: 2026

Type: article

Abstract: BACKGROUND: The hepatic vein-azygos vein connection is a rare Fontan modification used in patients with single ventricle physiology and interrupted inferior vena cava, following an initial Kawashima procedure. We report an unusual case of severe, late-onset hypoxemia due to recanalization of a hepatic vein-atrial communication after this operation. CASE SUMMARY: 35% to 40%) and polycythemia. Imaging demonstrated recanalization of hepatic vein-atrial communication resulting in significant right to left shunt and diffuse pulmonary arterio-venous malformations. Transcatheter closure of the communication using a 12-mm muscular ventricular septal defect occluder improved oxygen saturation to 65% with symptomatic relief. DISCUSSION: The hepatic vein-azygos vein connection represents an uncommon Fontan modification designed to ensure uniform distribution of hepatic venous flow to both the lungs. Late recanalization of a hepatic vein-atrial communication following this procedure has not been previously reported. In our case, transcatheter occlusion of the communication successfully redirected the hepatic venous flow to the pulmonary circuit. TAKE-HOME MESSAGE: We describe a previously unreported complication of a rare Fontan modification. Transcatheter closure of a recanalized hepatic vein-atrial communication can effectively restore Fontan physiology and improve systemic oxygenation.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.107033

Authors: Saileela Rajan, Arun Sundaram, Robert Coelho

Institution: Madras Institute of Orthopaedics and Traumatology

Language: English

Topic: Congenital Heart Disease Studies

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850