Early cardiac rehabilitation in pediatric fenestrated Fontan completion: A case report despite postoperative complication

ABSTRACT

Early rehabilitation after Fontan surgery in children is poorly described, especially in complicated postoperative courses. We report the clinical evolution and rehabilitation of an 8-year-old girl with double-inlet left ventricle and patent ductus arteriosus who underwent fenestrated Fontan completion. The postoperative period was complicated by bilateral pleural effusions, pulmonary hypertension, hematemesis, psychomotor alteration, and mechanical ventilation with inhaled nitric oxide. A structured bedside rehabilitation program was started early and adjusted according to clinical stability. The program included respiratory exercises, inspiratory muscle training, resistance exercises, cycle ergometry, and gait training. We observed progressive improvement in mobility, respiratory autonomy, and functional capacity. She was discharged from the pediatric cardiac intensive care unit on postoperative day 23, having demonstrated functional recovery. This was evidenced by a reduction in the Functional Status Scale score from 14 to 9. Early individualized rehabilitation after Fontan surgery was feasible and associated with meaningful functional improvement.