Journal of JCIC

Complications after Fontan surgery include thromboembolism, which can lead to cerebral infarction, pulmonary embolism, and Fontan circulation collapse. Transvenous embolectomy has been reported, but the choice of device varies from institution to institution. Our case is a 22-year-old female who underwent Fontan surgery at age 5 for Ebstein’s disease. She was urgently seen for pain in the left neck, axilla, and forearm, and swelling in the left upper extremity 4 days before the onset of the disease. A huge thrombus was found in the left internal jugular vein, subclavian vein, and innominate vein, and a left pleural effusion was observed. She underwent emergency transcatheter thrombolysis and aspiration. Thrombolysis and aspiration using a FOUNTAIN^® Infusion catheter and urokinase, and 7 Fr Eliminate^®+ (1.3 mm lumen) were not effective. The Agilis NxT Steerable Introducer with 8.5 Fr (2.8 mm) lumen and deflectable sheath enabled effective thrombus aspiration and easy approach to each vein. Sufficient patency was achieved by thrombus aspiration. The steerable sheath with a soft tip and large lumen was useful for aspirating large thrombi and safely reaching the target vessel with only the sheath.