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Chapter 28 - Lateral Tunnel Fenestrated Fontan

from Section 5 - Single-Ventricle Physiology

Published online by Cambridge University Press:  09 September 2021

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

The Fontan operation is the final stage of single-ventricle palliation that effectively separates the pulmonary and systemic circulations. The procedure connects the inferior vena cava directly to the pulmonary arteries or to the previously created superior cavopulmonary anastomosis, which allows all of the deoxygenated systemic venous return to flow directly to the lungs. The single ventricle then pumps oxygenated pulmonary venous blood to the systemic circulation. Baseline higher central venous pressure drives the Fontan circulation. There is an increased incidence of severe spinal deformities in children with congenital heart disease that will require corrective surgery, including posterior spinal fusion. Anesthesia for posterior spinal fusion in Fontan patients presents significant challenges, especially as the patient is in the prone position, which further exacerbates hemodynamic instability. This chapter discusses the perioperative management of a Fontan patient for posterior spinal fusion.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 207 - 216
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Schilling, C., Dalsiel, K., Nunn, R., et al. The Fontan epidemic: population projections from Australia and New Zealand Fontan registry. Int J Cardiol 2016; 219: 1419.CrossRefGoogle ScholarPubMed
Herrera Soto, J. A., Vander Hare, K. L., Barry-Lane, P., et al. Retrospective study on the development of spinal deformities following sternotomy for congenital heart disease. Spine 2007; 32: 19982004.CrossRefGoogle ScholarPubMed
Kadhim, M., Pizarro, C., Holmes, L., et al. Prevalence of scoliosis in patients with Fontan circulation. Arch Dis Child 2013; 98: 170–5.CrossRefGoogle ScholarPubMed
Soliman, D. E., Maslow, A. D., Bokesch, P. M., et al. Transesophageal echocardiography during scoliosis repair: comparison with CVP monitoring. Can J Anaesth 1998; 45: 925–32.CrossRefGoogle ScholarPubMed
Walker, C., Martin, D., Klamar, J., et al. Perioperative management of a patient with Fontan physiology for posterior spinal fusion. J Med Cases 2014; 5: 392–6.Google Scholar
Brown, Z. E., Görges, M., Cooke, E., et al. Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery. Anaesthesia 2013; 68: 742–6.CrossRefGoogle ScholarPubMed
Rafique, M. B., Stuth, E. A., Tassone, J. C.. Increased blood loss during posterior spinal fusion for idiopathic scoliosis in an adolescent with Fontan physiology. Pediatr Anesth 2006; 16: 206–12.CrossRefGoogle Scholar
Macarrón, C. P. C., Ruiz, E. S., Flores, J. B., et al. Spinal surgery in the univentricular heart – is it viable? Cardiol Young 2014; 24: 73–8.Google Scholar
Vischoff, D., Fortier, L. P., Villeneuve, E., et al. Anaesthetic management of an adolescent for scoliosis surgery with a Fontan circulation. Paediatr Anaesth 2001; 11: 607–10.CrossRefGoogle ScholarPubMed
Leichtle, C. I., Kumpf, M., Gass, M., et al. Surgical correction of scoliosis in children with congenital heart failure (Fontan circulation): case report and literature review. Eur Spine J 2008; 17: 312–17.CrossRefGoogle ScholarPubMed

Suggested Reading

Edgcombe, H., Carter, K., and Yarrow, S. Anaesthesia in the prone position. Br J Anaesth 2008; 100: 165–83.CrossRefGoogle ScholarPubMed
Kadhim, M., Pizarro, C., Holmes, L., et al. Prevalence of scoliosis in patients with Fontan circulation. Arch Dis Child 2013; 98: 170–5.CrossRefGoogle ScholarPubMed
Macarrón, C. P. C., Ruiz, E. S., Flores, J. B., et al. Spinal surgery in the univentricular heart – is it viable? Cardiol Young 2014; 24: 73–8.Google Scholar
Walker, C., Martin, D., Klamar, J., et al. Perioperative management of a patient with Fontan physiology for posterior spinal fusion. J Med Cases 2014; 5: 392–6.Google Scholar

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