The Fontan operation was first described in the literature in 1971 as a treatment for children with tricuspid atresia. 1 Before this procedure, children with single-ventricle anatomy had poor prognosis and early mortality. This was the first innovative approach that addressed and treated the cyanosis seen with mixing of venous and oxygenated blood. In the past 50 years, the Fontan operation has undergone many modifications and advancements to better improve outcomes and life expectancy. It has become the treatment strategy of choice for palliating singleventricle congenital heart diseases (Table 1). 2 The term palliating encompasses the idea that this procedure is not an anatomic correction, as this would require the creation of a dual ventricle circulation. The Fontan operation has improved life expectancy markedly for patients born with single-ventricle-type congenital heart disease. Being born with a single ventricle was once considered a near-fatal diagnosis, but survival rates of patients after palliative procedures have improved to nearly 90%. 3 As of 2018, it is estimated that there are 70,000 patients worldwide with Fontan circulation with an average patient age of 18 years in 2014. 4,5 Extrapolated to the present time, the average age of patients with Fontan circulation in 2021 is 25 years. As more women with Fontan circulation are becoming of childbearing age, anesthesiologists need to familiarize themselves on their altered physiology and how to best treat these patients throughout their pregnancy. This article will focus on Fontan circulation and its impact on the anesthetic management during the antepartum, intrapartum, and postpartum periods.

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