Anesthetic Management of Parturients With a Fontan Circulation

Abstract

Parturients with Fontan physiology provide unique and complex challenges to anesthesiologists. Such challenges include the maintenance of a perfect balance between preload, pulmonary vascular resistance, afterload, and cardiac output in a setting of a single ventricle physiology. The physiological changes of pregnancy add additional burden to an already "fragile" physiology, making the anesthetic management for labor and/or cesarean delivery even more complex. Understanding the impact of these changes on the Fontan physiology and the effect of anesthetic choices on this dyad (pregnancy-Fontan) is an imperative prior to caring for these patients. In an effort to determine how these patients are best managed for labor and/or cesarean delivery, we have reviewed the literature examining the peripartum anesthetic management of parturients with Fontan circulation and have identified 27 case reports.

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…Neuraxial anesthetic techniques can be safe in patients with Fontan physiology, which may be particularly useful for obstetric and gynecologic surgery, although careful titration of these agents is needed. 487 …”

Noteworthy Literature in 2015

“…This year there were many excellent reviews of managing the adult with CHD and pregnancy. 62-65 These reviews agree on many principles of managing this population, especially the importance of multidisciplinary preconception evaluation and planning. Often this evaluation and planning occurs after the patient is pregnant, and it is essential that cardiologists, obstetricians, and anesthesiologists work together and understand the pathophysiological implications of the CHD.…”

“…67 This is further reinforced by studies that report the successful use of neuraxial anesthesia in patients with Fontan physiology. 65,68…”

Cesárea electiva en paciente portadora de procedimiento de Fontan

“…Circulación de Fontan, embarazo, anestesia, ventrículo único, cardiopatía congénita nerando flujo sanguíneo pasivo con riesgo de tromboembolismo, arritmias y falla cardíaca [6], [7]. En esta paciente el procedimiento se realizó, primero conectando la vena cava superior a la arteria pulmonar y posteriormente conectando el resto del flujo venoso con un tubo intracardíaco.…”