Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery

McNamara, John R.; McMahon, Aisling C.; Griffin, Michael

doi:10.1053/j.jvca.2021.04.021

Cited by 18 publications

(12 citation statements)

References 79 publications

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“…Physicians caring for patients with a single ventricle should understand the anatomy and specific physiological vulnerabilities associated with each stage of palliation. [45][46][47]…”

Section: Single Ventriclementioning

confidence: 99%

See 1 more Smart Citation

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.

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“…Physicians caring for patients with a single ventricle should understand the anatomy and specific physiological vulnerabilities associated with each stage of palliation. [45][46][47]…”

Section: Single Ventriclementioning

confidence: 99%

“…The risk for thrombosis is elevated in patients with cyanotic HD and highest in patients with a single ventricle. 37,47 Depending on the indication for anticoagulation (eg, mechanical mitral or aortic valve), intravenous heparin may be required until oral anticoagulation can be reinitiated.…”

Section: Postoperative Carementioning

confidence: 99%

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…Dynamic physiological changes at delivery make anesthetic management very challenging in Fontan-palliated parturients [ 2 ]. The principles of hemodynamic management in Fontan circulation include maintaining preload and cardiac contractility and avoiding an increase in pulmonary vascular resistance [ 1 , 2 ]. Successful anesthetic management of cesarean delivery in patients with Fontan circulation has been reported [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…1 Fontan palliation establishes single-ventricle circulation by directing venous blood from the body to the pulmonary artery bypassing the ventricle. Cardiac output in such patients is highly dependent on the preload; thus, they are susceptible to hypotension due to blood loss [ 1 , 2 ]. Patients with placenta accreta spectrum (PAS) are at a high risk of rapid and massive peripartum hemorrhage [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

et al. 2023

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Background In patients with Fontan circulation, hemorrhage can cause life-threatening circulatory collapse, since Fontan circulation strongly depends on the preload. Furthermore, parturients with placenta accreta spectrum are at a high risk of rapid and massive hemorrhage. Herein, we report the case of an intra-aortic balloon occlusion used for a Fontan-palliated parturient with placenta increta with successful anesthetic management. Case presentation A 35-year-old-female with Fontan circulation diagnosed with placenta increta underwent a cesarean hysterectomy. The main goal during anesthetic management was to maintain sufficient preload. Infrarenal intra-aortic balloon occlusion was used to reduce intraoperative hemorrhage. The hemodynamic changes caused were well tolerated in this case. Conclusions Intra-aortic balloon occlusion was used in a Fontan-palliated parturient with placenta increta with successful anesthetic management.

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“…The evaluation of a child with Fontan circulation needs a multidisciplinary perioperative workup and has not been described well in current literature (McNamara et al 2022). Hence with this report, we attempt to elaborate the preparation of a child with Fontan heart undergoing laparoscopic cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of a child with Fontan heart undergoing laparoscopic cholecystectomy: A case report

Siddharth

Jayanthi

Manne

2023

Journal of Perioperative Practice

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The Fontan procedure is a staged palliative surgery performed in children with congenital univentricular heart defects. These individuals are predisposed to a variety of issues due to their altered physiology. Through this article, we would like to describe the evaluation and anaesthetic management of a 14-year-old boy with Fontan circulation who underwent an uneventful laparoscopic cholecystectomy. The key to successful management was a multidisciplinary approach throughout the perioperative period as these patients pose a unique set of problems.

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Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery

Cited by 18 publications

References 79 publications

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

Anaesthetic management of a child with Fontan heart undergoing laparoscopic cholecystectomy: A case report

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