Abstract
Laparoscopic surgery in patients with Fontan circulation is a haemodynamic challenge; venous return may be compromised by insufflation of carbon dioxide into the abdomen (increasing intra-abdominal pressure), the use of reverse Trendelenburg position and positive pressure ventilation. Combined with an increase in pulmonary vascular resistance due to hypercarbia, cardiac output may be reduced. However, for non-haemodynamic reasons, laparoscopic surgery has advantages over open surgery: less postoperative pain, shorter hospital stay, a reduction in postoperative wound infections and a reduction of respiratory complications. In this case report, we present a patient with Fontan circulation who underwent uneventful laparoscopic cholecystectomy.
Highlights
In a monoventricle circulation, such as the Fontan circulation, the venous return is connected directly to the pulmonary circulation without interposition of a right ventricle
In this case report, we present a patient with Fontan circulation who underwent uneventful laparoscopic cholecystectomy
With a maximal IAP of 10 mmHg, systolic blood pressure increased to 150/70 mmHg, cardiac output increased to a maximum of 7.8 l/min and the central venous pressure (CVP) increased to 20 mmHg (Fig. 2, insufflation)
Summary
In a monoventricle circulation, such as the Fontan circulation, the venous return is connected directly to the pulmonary circulation without interposition of a right ventricle. In this case report, we present a patient with Fontan circulation who underwent uneventful laparoscopic cholecystectomy. At the start of the procedure, the blood pressure was 100/40 mmHg; the cardiac output, 4.0 l/min; and central venous pressure (CVP), 11 mmHg (Fig. 2, start of procedure).
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