Anesthetic management of a patient with a single ventricle and modified Fontan procedure

Abstract

ECENT ADVANCES in surgical techniques and anesR thetic management have made possible the partial or complete correction of many congenital cardiac anomalies. During the past decade, procedures based on the concepts described by Fontan’ and by Kruetzer2 have been developed for the physiologic correction of tricuspid atresia and these have been modified and applied to other complex congenital anomalies. In the Fontan procedure systemic venous blood is directed from the right atrium into the lungs via the pulmonary arteries and pulmonary venous blood into the arterial circulation, thereby resulting in a physiologic correction of the congenital defect. Closure of the atria1 septal defect prevents mixing of oxygenated with deoxygenated blood. Patients treated with the Fontan procedure may attain adulthood and become candidates for noncardiac operations that necessitate anesthesia. The anesthetic management and rationale for this approach in a patient with a univentricular heart who had a modified Fontan procedure and who was scheduled for reduction mammoplasties are reported.