Congenital Heart Disease in the Adult Presenting for Noncardiac Surgery

Anesthetic Management of Resection of Metastatic Occipital Malignancy in a Patient With Fontan Physiology

“…The next of the staged procedures is typically performed in infancy and is known as the Glenn operation, wherein the superior vena cava is connected to the right pulmonary artery and divides the main pulmonary artery with the purpose of partially separating oxygenated and deoxygenated blood at the level of the ventricle [ 10 ]. This procedure is often delayed until three to nine months of life to allow for a decrease in PVR, that is necessary to allow for adequate flow through the shunt [ 2 ]. This has a dual physiological effect of decreasing the load on the single ventricle as the SVC return flows directly to the lungs, while maintaining preload as the IVC return to the single ventricle [ 10 ].…”

“…Finally, elevating the head or placing the patient in a sitting position may decrease venous return that may upset the balance of Qp/Qs and adversely affect pulmonary blood flow [ 10 ]. Patients who have undergone a fenestrated Fontan have an artificially created communication between arterial and venous circulations that may allow for systemic and paradoxical embolus [ 2 ]. It is essential to meticulously ensure that all lines are adequately deaired while remaining vigilant for the possibility of air entraining through the venous sinuses [ 10 ].…”

“…Globally, congenital heart disease (CHD) occurs in about 8-9 per 1000 live births, representing 28% of congenital defects in infancy [ 1 ]. Countless advancements have been made in the surgical management of CHDs over the last 30 years resulting in 85% to 90% of children born in the United States with congenital heart defects to survive to adulthood [ 2 ]. There are 800,000 to 1.2 million adults with treated CHD in the United States and it has been predicted that there will be soon more adult survivors with corrected CHD than children [ 3 ].…”

“…As a result, knowledge of the appropriate anesthetic management of adult patients with CHD presenting for noncardiac surgery is of the utmost importance. The recently published literature indicates echocardiography guidelines and expert opinions reflecting that this group of patients is at risk of experiencing increased perioperative morbidity and mortality [ 2 ]. We are presenting a case report of the anesthetic management of a 26-year-old female patient with Fontan physiology who presented for a left occipital craniotomy for the resection of a metastatic brain tumor, followed by a review of Fontan physiology and its implication for anesthesia.…”