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

JA Clinical Reports

Kazutomo Saito¹  Masanori Yamauchi¹  Hiroaki Toyama¹  Atsushi Okamoto² 

[1] Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, 980-8575, Sendai, Miyagi, Japan;Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, 980-8575, Sendai, Miyagi, Japan;

关键词: Adult congenital heart disease;    Tricuspid atresia;    Fontan circulation;    Cesarean section;    Central venous oxygen saturation;    Oxygen consumption;   

DOI  :  10.1186/s40981-020-00385-w

来源: Springer

【 摘 要 】

BackgroundThe 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 presentationA 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.ConclusionsIn a cesarean section for a Fontan-palliated parturient, ScvO2 dramatically increased and maternal VO2 decreased by more than 25% after delivery.

【 授权许可】

CC BY