Case Series Conference: Anesthetic Management in Parturients With Fontan Physiology.

The Fontan procedure is performed as the final stage of palliation for patients with single-ventricle congenital heart diseases, such as tricuspid atresia, hypoplastic left-heart syndrome, or severely unbalanced atrioventricular canal defect. It creates a functional series circulation in which all pulmonary blood flow is derived from the systemic venous return that subsequently supplies ventricular preload in the absence of a subpulmonic pumping chamber. Since its inception in 1971, surgical advancement in the Fontan procedure has led to improved long-term outcomes, with transplant-free survival reaching 84% at 20 years. 1 Fontan F Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971; 26: 240-248 Crossref PubMed Scopus (2114) Google Scholar ,2 Khairy P Fernandes SM Mayer Jr., JE et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation. 2008; 117: 85-92 Crossref PubMed Scopus (768) Google Scholar There are an estimated 28,000 adult patients with Fontan physiology alive worldwide, a population that is expected to double within 20 years. 3 Akintoye E Miranda WR Veldtman GR et al. National trends in Fontan operation and in-hospital outcomes in the USA. Heart. 2019; 105: 708-714 Crossref PubMed Scopus (32) Google Scholar ,4 d'Udekem Y Iyengar AJ Galati JC et al. Redefining expectations of long-term survival after the Fontan procedure: Twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation. 2014; 130: S32-S38 Crossref PubMed Scopus (421) Google Scholar Many of these patients are females of childbearing age, making pregnancy and childbirth in the parturient with Fontan physiology a reality. 5 Rychik J, Atz AM, Celermajer DS, et al. Evaluation and management of the child and adult with Fontan circulation: A scientific statement from the American Heart Association [e-pub ahead of print[. Circulation. doi: 10.1161/cir.0000000000000696. Accessed May 1, 2022. Google Scholar Assessing the Fontan Parturient; One Size Does Not Fit AllJournal of Cardiothoracic and Vascular AnesthesiaVol. 37Issue 1PreviewThis invited editorial is related to: Ref.: Ms. No. JCVA-D-22-00216R2 Case series conference: Anesthetic management in parturients with Fontan physiology “If you have choices choose the best. If you have no choices do your best!” Nishan Panwar Full-Text PDF