Managing Feeding Refusal as an Unusual Presentation of Severe Atrioventricular Valve Regurgitation in a PostFontan Patient with Down Syndrome.

Abstract

Background: Feeding refusal is an uncommon and often overlooked manifestation of hemodynamic deterioration in patients with Fontan physiology.

Case presentation: We report a child with trisomy 21 and unbalanced atrioventricular septal defect who presented several years after Fontan completion with progressive feeding refusal and ascites. Comprehensive evaluation revealed severe atrioventricular valve regurgitation without Fontan pathway obstruction. Medical optimization resulted in clinical improvement, and surgical valve repair was planned.

Conclusion: Feeding refusal may represent an early clinical clue of Fontan failure. Prompt recognition and multidisciplinary management are essential to optimize outcomes in this high-risk population.