Table 1: Preoperative evaluation.

PMHHypoplastic left heart
Sick sinus with pacemaker
Hypertension
Cirrhosis
Lung arteriovenous malformations

PSHNorwood (at birth)
Glen (at 4 m)
Fontan (at 5 y)
Cholecystectomy
Tonsillectomy
Wrist surgery
Esophagogastroduodenoscopy
Cardiac cath

Meds Spironolactone
Digoxin
Atenolol
Aspirin
Hydrochlorothiazide
Losartan
Pantoprazole
Potassium chloride

LabsHemoglobin 17.5, platelets of 100 [nadir 50]
AST 49, ALT 70
INR of 1.3
Na 123, K 3.7, Cr 0.73, HCO3 23
Albumin 4.8, total protein 7.2

EKGHeart rate 79 bpm, atrial-paced with 1o AV block, right access deviation,
incomplete right bundle branch block, right ventricular hypertrophy,
ST depression in precordial leads with T wave inversion (nonacute)

EchoGrossly adequate myocardial function, no Fontan obstruction, unobstructed atrial septal defect, mild aortic regurgitation

Cardiac CathPatent superior vena cava to right pulmonary artery conduit with a saturation of 88%, mean pressure of 14 mmHg,
inferior vena cava to left pulmonary artery conduit with a saturation of 85%, mean pressure of 14 mmHg