Background
In the Fontan procedure, a palliative operation for single-ventricle congenital heart disease, the systemic veins are connected directly to the pulmonary circulation without a subpulmonary ventricle. Individuals with Fontan circulation are at risk for heart failure and liver disease, with recurrent ascites being one cause of late morbidity.1 Ascites associated with heart failure or liver failure is usually characterized by a serum-ascites albumin gradient (SAAG)≥1.1.2 However, we have observed multiple instances of ascites in Fontan patients with low SAAG, suggesting a possible inflammatory process. We present three such cases in which recalcitrant ascites severely and adversely impacted quality of life, and describe our initial experience with intraperitoneal corticosteroids in this setting.