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Chapter 29 - Extracardiac Fontan

from Section 5 - Single-Ventricle Physiology

Published online by Cambridge University Press:  09 September 2021

By
Chinwe Unegbu  and
Nina Deutsch
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Single-ventricle physiology can arise from various anatomic and physiologic features beyond the most well-known hypoplastic left heart syndrome. In conditions that affect the pulmonary outflow tract, such as pulmonary atresia, initial palliative surgery often involves the placement of a modified Blalock–Taussig shunt, followed by a bidirectional Glenn and Fontan procedures. Older patients with Fontan physiology can have significant sequelae that are important to assess for preoperatively. Perioperative management of these patients requires attention to maintenance of adequate preload, ventilator strategies to promote pulmonary blood flow, and anesthetic techniques that account for potential long-term single-ventricle sequelae.

Keywords

dextro-transposition of the great arteries (d-TGA)Fontan physiologymodified Blalock–Taussig shuntpulmonary atresiasingle ventricle
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 217 - 225
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Jonas, R. A.. The intra/extracardiac conduit fenestrated Fontan. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annual 2011; 14: 11–18.CrossRefGoogle ScholarPubMed
Kay, A., Moe, T., Suter, B., et al. Long term consequences of the Fontan procedure and how to manage them. Prog Cardiovasc Dis 2018; 61: 365–76.CrossRefGoogle Scholar
Ajuba-Iwuji, C. C., Puttreddy, S., Maxwell, B. G., et al. Effect of preoperative angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use on hemodynamic variables in pediatric patients undergoing cardiopulmonary bypass. World J Pediatr Congenit Heart Surg 2014; 5: 515–21.CrossRefGoogle ScholarPubMed
Hollmann, C., Fernandes, N. L., and Biccard, B. M.. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg 2018; 127: 678–87.CrossRefGoogle ScholarPubMed
Tiouririne, M., De Souza, D. G., Beers, K. T., et al. Anesthetic management of parturients with a Fontan circulation: a review of published case reports. Semin Cardiothorac Vasc Anesth 2015; 19: 203–9.CrossRefGoogle ScholarPubMed

Suggested Reading

Kiran, U., Aggarwal, S., Choudhary, A., et al. The Blalock and Taussig shunt revisited. Ann Card Anaesth 2017; 20: 323–30.Google ScholarPubMed
McClain, C. D., McGowan, F. X., and Kovatsis, P. G. Laparoscopic surgery in a patient with Fontan physiology. Anesth Analg 2006; 103: 856–8.CrossRefGoogle Scholar
Nayak, S. and Booker, P. The Fontan circulation. Cont Educ Anaesth Crit Care Pain 2008; 8: 26–30.CrossRefGoogle Scholar

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