[II-JCKAP4-4] Interatrial Communication Restriction and Prolonged Pleural Effusion After Fontan Surgery in Hypoplastic Left Heart Syndrome
キーワード：Interatrial Communication Restriction, Prolonged Pleural Effusion, Fontan Surgery
Background: Prolonged pleural effusion is a significant complication observed after Fontan surgery. Case: A 2-year and 5-month-old boy diagnosed with hypoplastic left heart syndrome underwent sequential Norwood operation, bidirectional Glenn operation and Fontan surgery with an extra-cardiac conduit. Following the procedure, the patient experienced persistent massive pleural effusion, along with left pulmonary artery stenosis detected through enhanced computed tomography. Stent implantation was performed to improve the stenosis, but the pleural effusion persisted. Detailed echocardiography revealed accelerated blood flow in the interatrial communication without signs of pulmonary venous obstruction (PVO). The catheter examination confirmed that the conduit compressed on the atrium resulting restrictive interatrial communication. Conduit replacement and resection of the remnant of the interatrial septum were performed and halting the pleural effusion.Discussion: Prolonged pleural effusion after Fontan surgery is a serious complication, often attributed to factors such as PVO. The restriction of interatrial communication due to conduit compression has not been reported as a cause of this complication.Conclusion: Interatrial communication restriction after Fontan surgery due to conduit compression can contribute to prolonged massive pleural effusion. Vigilance regarding the Fontan circulation pathway, including monitoring for PVO and interatrial communication, is required.