Laparoscopic surgery in the pediatric patient post Fontan procedure

Abstract

We present two case reports describing laparoscopic surgery in patients who have undergone previous Fontan surgery and discuss the theoretical implications of laparoscopic surgery in these patients. A brief discussion of the late complications of Fontan surgery is included.

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

“…Increased intraabdominal pressure from insufflation and elevated arterial carbon dioxide tension in laparoscopic surgery will increase PVR and decrease cardiac output. Successful laparoscopic surgery has been described in functional Fontan [40,41]. Limiting insufflation pressure to 10-12 mmHg seems to reduce the adverse effects of laparoscopy in these case reports.…”

“…Various case reports have been reported with their successful anesthetic management [36][37][38][39][40][41][42][43][44][45][46], including a case for failing Fontan [47].…”

The Fontan circulation and right parietal craniotomy for seizures: the challenges of adult congenital heart disease

“…Thromboembolic complications are also a well-recognized source of morbidity, given the nonpulsatile and sometimes diminished flow through Fontan pathways [20]. Incidence ranges from 3% to 20% [21][22][23]. While the routine use of anticoagulation remains controversial, a recent outcome study found the absence of aspirin or warfarin therapy to be powerful independent predictors of mortality from thromboembolism [24].…”

Anesthesia for pheochromocytoma resection in a child with Fontan circulation

“…The procedure usually corrects cyanosis and imparts a good quality of life, but it has limitations that affect anesthetic management. 1 Patients with a single ventricle and residual right-to-left communication, e.g., Glenn shunts, receive blood from the venous side of the heart; however, in patients with a completed Fontan palliation, ventricular filling is dependent entirely on pulmonary venous return (Figure). These patients require an elevated central venous pressure (CVP), and a low-normal pulmonary and systemic vascular resistance to maintain pulmonary blood flow and cardiac output.…”