Thoracotomy And Scoliosis Surgery In A Patient With A Univentricular Heart

We report the case of a 15-year-old boy with a single left ventricle who underwent total cavopulmonary connection (Fontan circulation). Due to a progredient idiopathic scoliosis he had to undergo two surgical correction procedures of the vertebral column. Fontan circulation is characterized by the functional absence of the right ventricle. Blood from the systemic circulation passively flows directly into the pulmonary artery. Therefore, central venous preload as well as pulmonary vascular resistance gain essential significance for cardiac output. After volume preload, in both procedures anaesthesia was induced with etomidate and maintained intravenously with propofol and fentanyl but without N2O. Increases of the systemic and pulmonary vascular resistance were avoided. A central venous pressure of 20 mmHg was clinically associated with the most stable haemodynamics. In view of the electiveness of the present surgical procedures and with regard to an individual advantage vs risk estimation, tactical algorithms of action must be predefined on the basis of the individual physiology/pathophysiology to keep reaction times for necessary interventions brief.