The Correct Answer is C!

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A 44 year-old woman with complex tricuspid atresia underwent a Fontan procedure 5 years ago. In the past year, she has developed severe edema, ascites, and pleural effusions. She was found to have a serum albumin of 2.2 g/dL and total protein of 4.5 g/dL.

What is the next step in management?

  1. Bone marrow biopsy
  2. Paracentesis sent for cells and culture
  3. Alpha 1 antitrypsin level in stool
  4. Right and left heart catheterization with fluid loading

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