Successful One-Lung Ventilation in a Patient With the Fontan Circulation Undergoing Thoracoscopic Procedure

Cvetkovic, Draginja; Ramzy, Wassim; Vitale, Salvatore Giovanni; Malekan, Ramin; Warsy, Irfan

doi:10.1177/1089253214542252

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Contrary to these precedents, however, we did not encounter any major difficulties in the management of OLV in this patient. Given the limited number of available reports [9,10,13], it remains difficult to predict in which patients with Fontan circulation OLV would carry a higher risk of hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

One-lung ventilation in a patient with Fontan circulation undergoing diaphragmatic plication surgery: a case report

et al. 2019

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Background: Surgeries requiring one-lung ventilation (OLV) in patients with Fontan circulation pose great challenges. However, little information is available regarding the safety of OLV in Fontan patients when hemidiaphragmatic paralysis is present. Case presentation: A 41-year-old woman who underwent repeated Fontan procedures was re-admitted to our hospital because of worsening shortness of breath. As left hemidiaphragmatic paralysis was considered to be contributing to her symptom, an open thoracic left diaphragmatic plication surgery was scheduled. A preoperative pulmonary artery angiogram revealed a remarkably reduced blood flow to the left lung. The surgeon requested OLV during the surgery. Despite our concern regarding the impact of OLV on the Fontan circulation, OLV did not result in major hemodynamic changes. Conclusion: OLV can be safely implemented in patients with hemidiaphragmatic paralysis with preserved Fontan circulation. Preoperative pulmonary artery angiography may provide useful information for estimating the impact of OLV on the Fontan circulation.

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Section: Discussionmentioning

confidence: 99%

One-lung ventilation in a patient with Fontan circulation undergoing diaphragmatic plication surgery: a case report

et al. 2019

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Management of 1-Lung Ventilation in a Patient With Failing Fontan Circulation

Gregory

Swaminathan²,

Maisonave³

et al. 2016

A & A Case Reports

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The number of patients reaching adulthood after undergoing Fontan palliation for the repair of a congenital heart defect continues to increase. In this case report, we present the anesthetic management of a patient with a history of tricuspid atresia treated with palliative Fontan repair who had developed clinical evidence of Fontan failure. He presented with septic shock secondary to streptococcal toxic shock syndrome complicated by a loculated pleural effusion. He underwent open thoracic decortication under 1-lung ventilation. Discussion focuses on the management of volume status and pulmonary vascular resistance as well as surgical implications of Fontan physiology in thoracic surgery.

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Safe Anesthetic Management of One-Lung Ventilation in an Adolescent Patient With Fontan Circulation: A Case Report

Kawakami,

Ito,

Takazawa

2024

Cureus

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We present a case report on anesthesia management for a 16-year-old male with Fontan circulation undergoing pacemaker implantation, necessitating one-lung ventilation. The patient had a complex congenital heart condition and had previously undergone multiple surgeries, including a Fontan procedure. Due to his unique cardiovascular anatomy, a left thoracotomy was chosen for pacemaker implantation, which required one-lung ventilation for surgical approach and visualization. This procedure can pose significant risks in patients with Fontan circulation due to potential intraoperative increases in pulmonary vascular resistance, which is notoriously difficult to manage in the acute setting. Preoperative assessments showed that the patient had good exercise tolerance, preserved biventricular contractility, and normal liver and kidney function. However, he had a slightly elevated central venous pressure. We employed a meticulous anesthetic plan to minimize the risks associated with one-lung ventilation. This included inserting pre-induction arterial and central venous catheters, using total intravenous anesthesia with propofol and remifentanil, and administering circulatory support agents, such as dobutamine and norepinephrine. Arterial blood and central venous pressure were closely monitored throughout the procedure. Further, cardiac activity was monitored using transesophageal echocardiography (TEE). The patient's hemodynamic stability was maintained intraoperatively, and the pacemaker lead was successfully implanted without significant complications. Postoperatively, we administered continuous intravenous fentanyl infusion and intercostal nerve blocks for pain control. He had an uneventful recovery and was discharged from the intensive care unit the day after surgery. This case contributes to the limited but growing body of literature on anesthesia management in patients with Fontan circulation, particularly related to the use of one-lung ventilation, and appropriate selection of anesthetic agents and circulatory support drugs. Further research is necessary to establish best practices and improve surgical outcomes in these patients.

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Successful One-Lung Ventilation in a Patient With the Fontan Circulation Undergoing Thoracoscopic Procedure

Cited by 3 publications

References 5 publications

One-lung ventilation in a patient with Fontan circulation undergoing diaphragmatic plication surgery: a case report

One-lung ventilation in a patient with Fontan circulation undergoing diaphragmatic plication surgery: a case report

Management of 1-Lung Ventilation in a Patient With Failing Fontan Circulation

Safe Anesthetic Management of One-Lung Ventilation in an Adolescent Patient With Fontan Circulation: A Case Report

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