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Ann Thorac Surg 2007;84:2110-2112. doi:10.1016/j.athoracsur.2007.06.064
© 2007 The Society of Thoracic Surgeons
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Case Reports

Resolution of Protein-Losing Enteropathy With Low-Molecular Weight Heparin in an Adult Patient With Fontan Palliation

Kapil M. Bhagirath, MD*, James W. Tam, MD, FRCPC

Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Accepted for publication June 22, 2007.

* Address correspondence to Dr Bhagirath, c/o Dr Tam, Y3005–409 Tache Ave, Winnipeg, Manitoba, R2H 2A6, Canada (Email: umbhagir{at}cc.umanitoba.ca).

Protein-losing enteropathy is a well-known complication after the Fontan procedure, and unfractionated heparin therapy has been tried with some success as a potential therapy. Low-molecular weight heparin is believed to be ineffective. We now describe a case in which an adult patient with protein-losing enteropathy after Fontan palliation was successfully treated with systemic doses of low-molecular weight heparin, with complete resolution in the 24-hour fecal alpha-1 anti-trypsin level and serum albumin. The patient continues to remain in remission with this therapy. In conclusion, these findings are novel and compel us to re-evaluate our pathophysiologic understanding of this difficult condition.






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