Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery

Kazutomo Saito, Hiroaki Toyama, Atsushi Okamoto, Masanori Yamauchi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO2) and oxygen consumption (VO2) has never been reported. Case presentation: A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks’ gestation. During combined spinal-epidural anesthesia, ScvO2 in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO2 was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO2 increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO2 changed from 443 to 295 mL/min. Conclusions: In a cesarean section for a Fontan-palliated parturient, ScvO2 dramatically increased and maternal VO2 decreased by more than 25% after delivery.

Original languageEnglish
Article number77
JournalJA Clinical Reports
Volume6
Issue number1
DOIs
Publication statusPublished - 2020 Dec 1

Keywords

  • Adult congenital heart disease
  • Central venous oxygen saturation
  • Cesarean section
  • Fontan circulation
  • Oxygen consumption
  • Tricuspid atresia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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