The Fontan Circulation in Pregnancy: Hemodynamic Challenges and Anesthetic Considerations
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Issued Date
2024-01-01
Resource Type
ISSN
10530770
eISSN
15328422
Scopus ID
2-s2.0-85200408167
Journal Title
Journal of Cardiothoracic and Vascular Anesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Cardiothoracic and Vascular Anesthesia (2024)
Suggested Citation
Maisat W., Yuki K. The Fontan Circulation in Pregnancy: Hemodynamic Challenges and Anesthetic Considerations. Journal of Cardiothoracic and Vascular Anesthesia (2024). doi:10.1053/j.jvca.2024.07.021 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/100437
Title
The Fontan Circulation in Pregnancy: Hemodynamic Challenges and Anesthetic Considerations
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
Abstract
Pregnancy in patients with Fontan physiology presents unique challenges due to altered cardiovascular dynamics inherent to both conditions. The Fontan procedure reroutes venous blood directly to the pulmonary arteries, bypassing the heart, and necessitating precise regulation of pulmonary venous resistance and systemic venous pressure to maintain effective cardiac output. The significant cardiovascular adaptations required during pregnancy to meet the metabolic demands of the mother and fetus can overburden the limited preload capacity and venous compliance in Fontan patients, predisposing them to a spectrum of potential complications, including arrhythmias, heart failure, thromboembolism, and obstetric and fetal risks. This review delineates the essential physiological adaptations during pregnancy and the challenges faced by Fontan patients, advocating for a comprehensive care approach involving multidisciplinary collaboration, vigilant monitoring, tailored anesthetic management, and postpartum care. Understanding the complex dynamics between Fontan physiology and pregnancy is crucial for anesthesiologists to develop and execute individualized management strategies to minimize risks and optimize outcomes for this high-risk population.